Request Coaching Form

Basic Info

First name

Last name

Phone

Coaching Plan

Birthday

Month

Day

Year

What are your top 2 - 3 goals right now (fitness, health, mindset, etc.)?

Why are these goals important to you?

On a scale of 1-10, how committed are you to making changes right now? (1 = not ready, 10 = all in)

Have you worked with a coach before? If so, what did you like/dislike about that experience?

What do you feel has held you back in the past and what are your biggest struggles?

What habits and routines are you hoping to improve or build?

How do you typically handle stress, setbacks and days you fall off the wagon?

Do you currently follow any specific way of eating (e.g., low carb, intermittent fasting, intuitive eating, etc.)?

What's your typical day of eating like? (Be honest - we're here to improve not judge!)

Do you track food or macros? If yes, how consistently? (Again, be honest)

Any food allergies, intolerance, or strong preferences I should know about?

What's your current activity level? (Workouts, walking, sports, job, etc.)

What types of movement do you enjoy - or want to enjoy?

Do you have any injures, limitations, or chronic pain I should be aware of?

Do you have access to a gym or home workout equipment?

Height & Weight

Any known medical conditions I should be aware of?

Are you currently taking any medications or supplements? If yes, please list

How many hours of sleep do you usually get per night?

How would you rate your current stress level?

Preferred Method of Communicaiton for checkins

Is there a day that works best for your weekly check-ins?( I’ll aim to match it as best I can.)

Is there anything else you would like me to know about you, your goals, or your journey so far?