Full Name *

Phone *

Email *

Date of birth *

City *

State *

Country *

Your biological gender? *

Male

Female

What is your occupation? *

Where are some places you have enjoyed traveling to? *

What do you feel passionate about? *

What do you feel you are currently struggling with? *

How has your health & body image impacted you emotionally? *

What goals do you have for your health, fitness & life that you would like support in accomplishing, and in what time frame? *

What do you feel is preventing you from achieving those goals? *

How do you envision your life 6-12 months from now having taken action RIGHT NOW and achieving those goals? *

How do you envision your life 6-12 months from now having NOT taken action right now and CHOOSING to perpetuate the same undesired circumstances you create for yourself? *

What does your daily nutrition look like? Please list everything you ate yesterday and at what time (as closely as you can recall). *

Nutritionally, what has worked well for you in the past? *

Nutritionally, what has NOT worked well for you in the past? *

Are you willing to eat meat (especially beef?) *

Yes! Give me all the organic, sustainably raised, pastured BEEF, pork, poultry and wild-caught fish!

I do not eat meat but I am open to learning and exploring eating meat.

No, I refuse to eat red meat or any other animal product.

Do you have any food allergies, intolerances, or dietary restrictions? If so, please list them. *

What is your current physical activity level? *

Consistent (3-5+ days per week)

Inconsistent (a couple days here any there, then several days or weeks of inactivity)

Nonexistent

Do you have any previous or current medical conditions/injuries/aches/pains/limitations or other physical issues I should be aware of? *

Are you currently pregnant?

Yes, I'm pregnant

No, I'm not pregnant.

Have you ever had a fitness coach before? Check all that might apply *

Yes, an in-person trainer

Yes, an online coach/trainer

Yes, my high school or college sports coaches/trainers

Do you have access to a gym or do you prefer to work out at home? *

I have access to a gym

I prefer to work out at home

I would like to do both

Why did you choose to apply for my coaching program? Why do you think that I can specifically help you achieve your goals, and what do you think my coaching can help you achieve? *

If we are a good fit for each other, are you both able and willing to make the investment your health requires by hiring me as your coach? *

I am ALL IN (physically, mentally, emotionally, spiritually, financially) and feel ready to transform my life and grow in strength, confidence & empowerment - no matter the cost

I have a tight budget, but my health is a top priority right now and I am willing to become resourceful and do what it takes to make this work for $500-$1,000 per month.

I am just looking for free guidance at this time.

Is there anyone else who may be involved in your decision to hire a coach or who might influence your commitment to consistently practice new, healthier lifestyle habits (spouse, partner, parent, friend, colleague, roommate, etc.)? *

Is there anyone else involved in your making financial decisions (spouse or parent) that needs to be present during your consultation call? If so, who will be attending our call with you? *

Do you understand that there is no magic pill, prenatal horse hormones or wrap or juice cleanse or MLM PRODUCTS or celebrity detox tea that will get you where you need/want to be, and that only the discipline YOU CHOOSE to practice daily will lead you to achieving the success results you desire? *

Yes! I know it won’t be easy, obstacles will arise and there will be times that I’ll surely want to quit, but I am worthy of improving my health and I am prepared to make changes.

No, I don’t want to change. Looks like I need to find another “coach” that will further enable me and become rich upon my fears, insecurities, excuses, laziness, and poor habits.

Is there anything else I might be missing that I should be asking and/or that you would like me to know about you? *

By submitting this application, I agree to (check all that apply) *

Prioritize my health and invest in myself

Have an open mind and be coachable

Let go of my excuses & limiting beliefs in order to transform my life & achieve my goals

Consistently complete workouts & make healthy nutrition choices when I don't want to

Actively engage in group discussions and live coaching calls

*PRACTICE* TREATING MYSELF WITH MORE LOVE & COMPASSION instead of harshness, since that clearly isn't enjoyable, hasn't worked in the past and won't work well for the long-term

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