check

One-On-One Coaching Application

Thank you for your interest in working with me!

Please take a moment to complete this application in as much detail as possible. Please note that the answers will not save if you exit out of the page without submitting it at the end. I'd recommend blocking off at least 10-minutes to complete this! 

Click the button below to start.

Start

Question 1 of 15

First & Last Name

Question 2 of 15

Email Address

Question 3 of 15

Gender

A

Female

B

Male

Question 4 of 15

Age

Question 5 of 15

Where are you located and what is your current job/occupation? 

Question 6 of 15

How did you hear about 1-on-1 coaching with me?

Question 7 of 15

What is your #1 goal and where would you like to see yourself in the next 6 to 12 months?

Question 8 of 15

What do you feel is holding you back from achieving this goal on your own?

Question 9 of 15

Do you currently (or have you ever in the past) followed a specific dietary protocol? (i.e., Ketogenic, Atkins, Vegetarian, Vegan, Paleo, IIFYM, etc.) Please explain.

Question 10 of 15

How familiar are you with tracking your food intake (calories, carbs, fat, protein) using a tracking app?

Question 11 of 15

Are you willing to track calories and macros to achieve your goals?

A

Yes

B

No

Question 12 of 15

Do you currently follow a specific exercise regimen? (please explain)

Question 13 of 15

Do you suffer from any medical conditions? (diabetes, autoimmune, high blood pressure, etc.)

Question 14 of 15

How willing and able are you to invest in yourself at this time? (time, resources, finances, current commitments).

 

*Please note that I require a minimum 3-month commitment for all 1-on-1 clients.

Question 15 of 15

Anything else you’d like me to know?

Confirm and Submit