Client Application

Please answer the questions below with as much detail as possible to help us assess your needs and determine if we will make a good team to achieve your goals.

We truly appreciate you taking the time to share you information, and we look forward to learning more about you! <3

How did you hear about us?

Which services are you interested in?

Personal Training

Nutrition Coaching

Health & Wellness Coaching

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Current Weight in Pounds

How would you describe your health?

Do you have or has your doctor or another licensed healthcare professional told you thatyou have any of the following conditions?

LIFESTYLE INFORMATION

Which best describes your activity level at your job and daily life?

Sedentary - Work a desk job and engage in very little exercise or chores

Lightly Active - Do chores and go on long walks/engage in exercise at lease 1 to 3 days in a week

Moderately Active - Move a lot during the day and workout (moderate effort) at least 3 to 5 days in a week

Very Active - Play sports or engage in vigorous exercise on most days

Extra Active - Do intense workouts 6 to 7 days a week with work that demands physical activity

Do you currently weigh yourself on a regular basis?

Yes

Do you consume alcohol?

Yes

How would you rate your current level of stress? (10 = Extremely Stressed, 0 = Not Stressed at All)

On average, how many hours of sleep do you get a night?

Do you prepare most of your meals?

Yes

How many meals do you typically eat each day?

Have you ever counted macros or calories before?

Yes

Do you know your current daily caloric intake?

Yes

What is your daily caloric intake?

How familar are you with macros? (10 = Extremely Familiar, 0 = Not at All Familiar)

Have you or do you currently follow a modified diet to manage a health condition?

Yes

Which best describes your current diet?

How would you rate your knowledge of nutrition? (10 = Extremely Knowledgeable, 0 = Not at All Knowledgeable

PHYSICAL ACTIVITY HISTORY

Do you count or track your daily steps?

Yes

On average, how many steps do you get in a day?

Are you currently physically active on a weekly basis?

Yes

Please list your favorite physical activities.

What is your ideal duration for a workout session?

Please check the box that best describes how ready you are to make the changes to your lifestyle to achieve these goals.

On a scale from 0-10, how important is this change to you? (10 = Extremely Important, 0 = Not at All Important)

Have you worked with a personal trainer, nutrition coach, or health coach before?

Yes - In Person

Yes - Online

I declare that the info I’ve provided is accurate & complete.

Thank you for submitting!

Please Book A Call (No sooner than 24 hours) for us to discuss your application and see if we make a great fit for each other!

Schedule Initial Discovery Call Here

Measure Backwards -

Certified Online Fitness Coaching

GENERAL INFORMATION

MEDICAL INFORMATION

LIFESTYLE INFORMATION

NUTRITION HISTORY

PHYSICAL ACTIVITY HISTORY

HEALTH GOALS