Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Age
How did you hear about my coaching?
Please check as many as apply
If you chose word of mouth, who referred you?
What type of coaching are you looking for?
*
Choose as many as apply
If you chose "Something else" please describe what you're looking for:
Have you ever worked with a coach before?
Yes
No
Please describe your previous coaching experiences
Do you have any specific wellness or fitness goals?
Please describe:
How important are these goals to you?
Extremely important
Somewhat important
Neither important nor unimportant
Not very important
I couldn't give less of a crap
How long have you been thinking about these goals?
How long have you been working on these specific goals?
What would it mean to you to achieve these goals?
Do you foresee any obstacles between yourself and your goals?
Yes
No
If yes, please describe potential obstacles:
After one month working together, what would successful training look like to you? What about after 6 months?
Are you currently exercising or engaging in a movement practice?
Yes
No
If yes, please describe. If no, please explain why not:
Remember, there's no wrong answer!
Do you have any current injuries or pain?
Please describe:
Please provide a brief history of injuries, surgeries, or conditions that might impact your training:
To what extent do you agree with the following statements?
I need help with exercise programming
I need help with exercise form
I need help with accountability
I just want someone to tell me what to do, I don't care about the technical stuff
I like working out with a group
I like working out at home
I feel comfortable in a gym setting
I feel pressure to exercise to look a certain way
I like mainstream exercise like lifting weights, running, etc
I'm interested in learning about and trying different forms of movement and exercise
I engage in physical activity for stress relief
I am happy with my current exercise routine
I have trouble sleeping
Food stresses me out
The thought of exercising stresses me out
I have a lot of energy to give to working out
I don't have much time to exercise
Exercise is a big part of my life
Terminator 2 is the best action movie of all time
What is your comfortable price range (per month if you're looking for ongoing coaching)
$0-$50
$50-$100
$100-$200
$200-$300
$300-$400
$400+
Do you have any hopes or expectations for coaching?
What made you reach out to me today?
What is your preferred method of communication?
How would you rate your confidence in this upcoming training experience?
CAN'T WAIT IT'S GONNA RULE!!
Pretty stoked
I am neutral and without emotion
Feeling hesitant....
Kinda terrified, tbh
Do you use social media? Feel free to share handles (this is mostly so I can connect the dots if you already follow me):
Would you like to sign up for my email list?
I promise never to use your information for nefarious purposes.
Finally, anything else you want to share or think I should know?