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Client Application Form
What is your first and last name?
*
How old are you?
*
What is your gender?
*
A
Female
B
Male
C
Prefer not to say
What is your phone number?
*
What is your email address?
*
What time zone are you in? Where are you located?
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How did you hear about me? (If you are a referral, who referred you?)
*
What are your top 3 fitness goals?
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Build muscle and get stronger
Reduce fat or lose weight
Gain or maintain weight
Improve eating habits
Increases energy levels/Improve sleep
Look better
Feel better
Reduce Stress
Which of the following do you struggle with the most?
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What do you think your life would look like in a year if you had a program that was specifically designed to you and your goals?
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On a scale of 1 to 10, how committed are you to achieving your fitness goals?
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1 being not committed, 10 being HELL YES
0
1
2
3
4
5
6
7
8
9
10
Will you be going to the gym for your workouts?
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A
Yes!
B
Possibly, I just need help.
C
No, I only want to do at home workouts
How many days per week can you realistically commit to training?
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1 stars
2 stars
3 stars
4 stars
5 stars
6 stars
7 stars
Tell me about any previous fitness programs or coaching you’ve tried. What did you enjoy most, and what didn’t work for you?
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How do you respond to direct coaching or feedback?
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A
Great. I take what feedback and implement it!
B
I am open to feedback but I am not good at implementing it.
C
I do not take coaching or feedback well AT ALL
If applicable, does your spouse or significant other support your decision to invest in yourself and in your health?
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A
HELL YES
B
No
C
Not sure, I have to ask
D
Not applicable
If this program is right for you, are you willing to make the financial investment?
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A
I am ready to commit no matter the cost
B
I can get resourceful if its the right fit for me
C
I am on the fence, I need more info
D
I have a very tight budget and can't do it if coaching is more than $75 a month
I operate only from a HELL YES in my life, everything else is a no. If we get on a call and it's a HELL YES to work together are you willing and able to make the investment in yourself to hire a coach?
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HELL YES
No
Agree and Submit
