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Fill in the options below to see if we’re a fit to work together!
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Please complete this application, this will give me a broader knowledge of your history and where you're at now. The data on this form will be collected and only accessible by you (the client) and myself.
On a scale of 1-10 how happy are you with your body right now?
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Name
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First
Last
Age
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Gender
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Male
Female
Phone Number
Email
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What's your favourite Movie?
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Do you like pineapple on your pizza?
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This is important...
Which option BEST describes your current situation?
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Lean/thin but want to gain muscle and strength
Burn body fat/get lean and look good naked
Lose weight and shape/tone my body
I've got some muscle on my frame but want to get shredded
Other
Training experience
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I've literally been winging it
1-6 months
6-12 months
1-3 years
Over 3 years
How long you've been lifting weights and/or following a structured plan with consistency.
Do you have any nutritional restrictions?
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Any health issues or major injuries/limitations?
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What do you feel is the biggest obstacle to achieving your dream body?
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What challenges are you facing?
Please describe your existing past diet history? What have you tried that hasn't worked?
Have you ever had a Personal Trainer/Coach before?
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Yes
No
In an ideal world can you describe what kind of shape you'll be in in 6-12 months?
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How did you find out about my Coaching services?
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Why did you choose specifically to apply to my coaching program?
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How commited are you to finally finding the solution to your problems and taking control of your health and body once and for all?
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I'll eat blended tuna and kale all day, every day if that's what it takes!
I'm definitely ready, just a little apprehensive
Yeah I'm kind of ready but... Oh look, there's a butterfly! So pretty...
I just slept for 14 hours straight, I think I deserve a nap.
Are you prepared to invest in achieving your goals and gaining complete control over your health and body?
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If I got the results I want then absolutely.
A little hesitant because of all the false promises in the past, but open to it
I'd rather keep wasting money on gimmicks and fads and stay stuck where I am
If I do become a client I accept the terms and conditions and privacy policy.
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I accept
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