First Name

Last Name

Phone *

Email *

Instagram Handle

What are your top 3 health and fitness related goals? (Be specific; include a measurable outcome and timeframe)

E.g., I’d like to lose 10 lbs in the next 12 weeks
E.g., I’d like to add 20 lbs to my squat in the next 3 months
E.g., I’d like to learn how to better manage my nutrition while eating out

Health and fitness goal #1

Health and fitness goal #2

Health and fitness goal #3

What are the main struggles you've experienced that have prevented you from achieving your goals?

Do you have any prior weight lifting/strength training experience?

Yes

Some - minimal

Do you have access to barbells and dumbbells to train?

Yes

Are you familiar with/willing to track your calories?

Yes

If not, are you willing to learn?

Yes

Have you ever been diagnosed with an eating disorder/ do you have disordered eating behaviors?

Yes

If yes, please explain

Are you willing to commit to following our coaching program for at least 6 months?

Yes

Are you in a position where you can invest significant focus, energy, and finances to achieve your goals?

Yes

Our coaching program requires you to:

Check in with your coach in a timely fashion
Be open minded and coachable
Keep your word and follow through with the commitments you’ve made to us and to yourself.

If we are a good fit to work with you, are you confident you will carry through with these requirements?

Yes

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