1:1 Fitness & Wellness Coaching Application ✨

Ready for a plan that actually fits your goals, lifestyle, and experience?

Fill out this short application so I can learn more about you, what you're working toward, and whether my coaching is the right fit for you.

This form is for fitness and wellness coaching and is not medical care or a substitute for evaluation or treatment by your healthcare provider.

What are your primary goals?
Select all that apply.

Improve overall fitness

Improve consistency/accountability

Improve nutrition habits

Prepare for a bodybuilding competition

Improve my health (labs, BP, blood sugar)

What would you most like to change over the next 3–6 months?

How would you describe your training experience?

How many days per week are you currently training?

Where will you primarily train?

Apartment/hotel gym

At home with minimal equipment

What equipment do you have access to?

What does your current training routine look like?

What do you feel is holding you back most right now?
Select up to 3.

I don't know what exercises/program to follow

Progress has stalled

I don't know how hard/heavy to train

Travel/work schedule

Nutrition & Lifestyle

How would you describe your current nutrition?

I track calories/macros consistently

I track occasionally

I generally eat intuitively

I follow a structured meal plan

I don't currently have much structure

Do you have any dietary restrictions, allergies, intolerances, or foods you avoid?

What does a typical day of eating look like for you?

On average, how many hours do you sleep per night?

How active are you outside of planned workouts?

Very active/physical job

Health & Exercise Readiness 🩺

These questions help me understand whether modifications or medical clearance may be appropriate before beginning an exercise program. Please answer honestly. Your health history will not be used to diagnose or treat medical conditions.

Have you been diagnosed by a healthcare professional with any medical conditions that may be relevant to exercise, nutrition, or recovery?

Do you currently have any injuries, persistent pain, physical limitations, or movement restrictions?

Has a healthcare professional ever told you that you should avoid, restrict, or modify exercise?

Are you currently pregnant or postpartum?

Prefer not to answer

Are you currently taking any medications that your healthcare provider has told you may affect exercise tolerance, heart rate, blood pressure, hydration, or recovery?

What are you looking for from a coach?
Select all that apply.

A structured training plan

Exercise/form guidance

Help breaking through a plateau

Bodybuilding guidance

Which coaching option are you most interested in?

Month-to-Month — $200/month

3-Month Commitment — $190/month ($570 total)

6-Month Commitment — $180/month ($1,080 total)

Not sure — I'd like help choosing

What type of coaching helps you most?

Lots of accountability/check-ins

Give me the plan and let me execute

Somewhere in between

How ready are you to make changes right now?

1 — Just exploring

5 — Ready to start

When would you ideally like to start?

Just researching for now

Why are you interested in working with me specifically?

Is there anything else you'd like me to know?

I understand that this service provides fitness/wellness coaching and education and does not constitute medical diagnosis or treatment. I understand that I should consult an appropriate healthcare professional regarding medical concerns or before beginning exercise when appropriate.

I confirm that the information I've provided is accurate to the best of my knowledge and agree to communicate any relevant changes that could affect my ability to participate safely.

1:1 Fitness & Wellness Coaching Application ✨

About You

Full name

Email

Age

Instagram handle

What are your primary goals?
Select all that apply.

What would you most like to change over the next 3–6 months?

Training

How would you describe your training experience?

How many days per week are you currently training?

Where will you primarily train?

What equipment do you have access to?

What does your current training routine look like?

What do you feel is holding you back most right now?
Select up to 3.

Nutrition & Lifestyle

How would you describe your current nutrition?

Do you have any dietary restrictions, allergies, intolerances, or foods you avoid?

What does a typical day of eating look like for you?

On average, how many hours do you sleep per night?

How active are you outside of planned workouts?

Health & Exercise Readiness 🩺

Have you been diagnosed by a healthcare professional with any medical conditions that may be relevant to exercise, nutrition, or recovery?

Do you currently have any injuries, persistent pain, physical limitations, or movement restrictions?

Has a healthcare professional ever told you that you should avoid, restrict, or modify exercise?

Are you currently pregnant or postpartum?

Are you currently taking any medications that your healthcare provider has told you may affect exercise tolerance, heart rate, blood pressure, hydration, or recovery?

Coaching Fit

What are you looking for from a coach?
Select all that apply.

Which coaching option are you most interested in?

What type of coaching helps you most?

How ready are you to make changes right now?

When would you ideally like to start?

Why are you interested in working with me specifically?

Is there anything else you'd like me to know?

Consent

1:1 Fitness & Wellness Coaching Application ✨

About You

Full name

Email

Age

Instagram handle

What are your primary goals?Select all that apply.

What would you most like to change over the next 3–6 months?

Training

How would you describe your training experience?

How many days per week are you currently training?

Where will you primarily train?

What equipment do you have access to?

What does your current training routine look like?

What do you feel is holding you back most right now?Select up to 3.

Nutrition & Lifestyle

How would you describe your current nutrition?

Do you have any dietary restrictions, allergies, intolerances, or foods you avoid?

What does a typical day of eating look like for you?

On average, how many hours do you sleep per night?

How active are you outside of planned workouts?

Health & Exercise Readiness 🩺

Have you been diagnosed by a healthcare professional with any medical conditions that may be relevant to exercise, nutrition, or recovery?

Do you currently have any injuries, persistent pain, physical limitations, or movement restrictions?

Has a healthcare professional ever told you that you should avoid, restrict, or modify exercise?

Are you currently pregnant or postpartum?

Are you currently taking any medications that your healthcare provider has told you may affect exercise tolerance, heart rate, blood pressure, hydration, or recovery?

Coaching Fit

What are you looking for from a coach?Select all that apply.

Which coaching option are you most interested in?

What type of coaching helps you most?

How ready are you to make changes right now?

When would you ideally like to start?

Why are you interested in working with me specifically?

Is there anything else you'd like me to know?

Consent

What are your primary goals?
Select all that apply.

What do you feel is holding you back most right now?
Select up to 3.

What are you looking for from a coach?
Select all that apply.