Application to Work with Nancy Di Nino Health and Fitness Coaching LLC

Nancy's programs provide high-value coaching for long-term results. Our clients are open to change, committed to the process, are coachable and are not looking for a quick fix. During the interview process, we will be addressing current lifestyle, habits and how you will adapt to the changes of a new program. If it is determined that Nancy's program will be mutually beneficial, then a follow up strategy call will be scheduled to determine program, duration and price based on your goals.

Full Name

Email *

Phone *

What time zone are you in? *

Social Media Handle: *

What is your age? *

What is your height (in feet and inches)? *

What is your current weight (in pounds)? *

What is your occupation? PT/FT/Night shift? *

What is your attitude toward exercise and strength training? *

I enjoy it - exercise and strength training are a part of my everyday lifestyle

I am okay with it - but I don't really like to exercise

I see exercise as a must in my life and treat it like any other appointment in my calendar

If you are currently exercising, please indicate what type of workout that you are currently doing? *

Strength training at home (dumbbells, bands, etc)

Strength training at gym (weights/machines, squat rack, etc)

Cardio - Pelaton, treadmill, elliptical, walking

Yoga & Pilates

Group/Boutique Classes (Orange Theory, F45 or similar)

How many days per week are you willing to commit to a GYM workout? *

3 days per week

4 days per week

5 days per week

Please provide a brief summary of your current fitness levels? *

What is your main fitness goal right now? Please give as much detail as possible and include your WHY for wanting to make these changes. *

Why do you want to work with ME? Please be specific. *

Are you... *

Pre-menopausal

Peri-menopausal

Menopausal

I don't know

Are you currently on any hormonal treatment (HRT)? *

Do you have any medical conditions we need to be aware of? (High Blood Pressure, Heart Disease, Diabetes, etc). If so, please explain. *

Do you drink alcohol? If so, how often? *

Do you have a history of substance abuse? If yes, please describe. *

Do you smoke? If so how much? *

How comfortable are you with online applications and tech gadgets? (We use online applications to communicate daily and require you to wear a heart rate tracking device, such as an Apple Watch or FitBit, to monitor your biometrics) *

I am a beginner (I can email my friends and family and wear a watch)

I am good with apps and tech (I have a social media account and already wear an Apple Watch or FitBit

I am a pro (I already log my food online and/or I use apps and programs in my line of work)

Nancy's programs provide high-value coaching for long-term results. The price varies depending on your goal, duration & the level of support & face time access you may require. The minimum commitment is usually 6 months or greater. Are you willing to commit to a program with this duration? *

Yes

No - this program is not for me

What has been the most that you have spent on your health and fitness in the past (USD)? *

NDF does have options to finance your membership, allowing you to apply monthly installment payments towards your investment. This option is through our financing partners. Would you be interested in this kind of option? *

Yes

If you find the program a perfect fit for you and will give you the best chance at achieving your goals, are you ready to get started and take action immediately? Or is there anything that would prevent you from starting right away? *

How are you going to make Nancy's Coaching Program a part of your lifestyle? *

Is the decision to financially invest in your health your decision or do you need to consult with your spouse? If yes, kindly ensure to do so prior, or ensure they are present to make a well informed decision on the call. *

The decision is mine to make

I will need to consult with my spouse before making a decision to financially invest in my health & fitness goals and AGREE to do that BEFORE the call.

I will need to consult with my spouse before making a decision to financially invest in my health & fitness goals and AGREE TO HAVE THEM ON THE CALL so a decision can be made.

I confirm and understand working with Nancy and her Coaching program is a serious commitment to achieve long lasting sustainable results. I will remain coachable and be open to learning new techniques. I will hold myself accountable and will learn to be independent so that I may sustain my lifestyle even after my membership. *

Yes I Do

I Am Not Sure

I agree to show up for a free discovery ZOOM call from a desktop computer - DISTRACTION FREE - ready to focus with Nancy and her team *

I understand

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