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

This is where it all begins.
You’re not just filling out a form. You’re taking the first real step toward becoming the strongest version of yourself in your prime midlife era.

This application helps us get a clear picture of where you’re at and where you want to go. From there, we’ll figure out which of my programs makes the most sense for you. If it feels like the right fit on both ends, we’ll hop on a strategy call and map out your personalized training plan.

I work with women who love to lift but want to take their progress to the next level. Women who are ready to show up, get honest, and go all in on themselves.

If that’s you, I’m ready when you are.

Full Name *

Email *

Phone *

What time zone are you in? *

What is your age? *

Are you... *

Pre-menopausal

Peri-menopausal

Menopausal

N/A

Are you currently on any hormonal treatment (such as HRT or functional medicines)? *

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 main fitness goal right now? (fat loss, improve my form, improve muscle definition, ect) *

What have you tried to achieve this goal? (hired a personal trainer, online fitness, etc.) *

What do you think has contributed to you not being able to obtain these goals? *

WHY do you want to work with ME? There are 1000s of coaches out there, what inspired you to want to work with me and my team.

Describe your current fitness regimen? How many days per week? How long have you been training consistently?? *

Describe your gym setting. Do you have a membership to a big box gym like Golds, Planet Fitness, LA Fitness. Or a small but well equipped gym like YMCA, Anytime Fitness, Snap Fitness. Or do you belong to a boutique, personal training studio like Orange Theory, Yoga or Pilates studio. Or if you work from home, note HOME. *

If you use a home gym ONLY, what type of equipment is available to you?

If you do not have the necessary home equipment for your goals, are you willing and open to investing in the recommend necessary equipment or a gym membership with the recommended equipment?

Absolutely!

Going to the gym is not an option for me

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

Part of Nancy's process is temporarily removing sugar, alcohol, gluten and dairy from your nutrition..if it meant reaching your goals are you will to commit to this process? *

Yes, absolutely!

I'd like to discuss further.

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

Do you smoke? If so how much? *

What is your comfort level when it comes to tech? *

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)

If you’re selected for our elite coaching program where your training, nutrition, and hormones are personalized and you work closely with Nancy and her team each week, are you ready to commit to showing up for yourself for a minimum of six months? *

Yes

Yes, but I do have an upcoming vacation/travel/event

No I cannot commit to 6 months, but will consider other options

What type of fitness training have you dedicated the most time and investment to previously? *

I've never spent money on do it myself fitness programs

I have spent money on an in-person personal trainer

I have invested in a gym membership

I've never spent money on Studio Fitness Classes (Orange Theory, Pelaton, Boot Camp)

I've never spent money on an online personal trainer/program

If you're selected for one of our elite or premium coaching programs, full payment is required to secure your spot. We do offer financing options through our trusted partners, which allow you to break your investment into monthly installments. Would you be interested in exploring that option if needed? *

Yes

No, but I will consider other options to work within my budget

Once we match you with the transformation program that fits your goals, and it feels like the right move for you—are you ready to take action and get started right away? Or is there anything that might hold you back from beginning now? *

When it comes to making a financial investment in your health, is that a decision you make on your own or one you’d want to talk through with your spouse or partner? If so, we’d love for them to join us on the call so everyone’s on the same page. *

The decision is mine to make

I’d like to talk it over with my spouse before making a financial investment in my health and fitness goals, and I agree to have them join the call so we can make the decision together on the call.

What are you currently ready to invest towards reaching your goals monthly?

I understand that working with Nancy and her coaching team is a serious commitment to creating lasting, sustainable results. I’m open to learning new methods, staying coachable, and holding myself accountable throughout the journey. I’m committed to building the independence and confidence needed to maintain this lifestyle long after my membership ends. *

Yes I Do

I Am Not Sure

I agree to show up for my complimentary Discovery Zoom Call from a desktop or laptop, fully present and distraction free, ready to focus and connect with Nancy and her team. *

I understand

We understand that life happens. That said, please note we do not offer rescheduled calls for anyone who misses their appointment without providing prior notice. *

I understand

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