Group Coaching Application Form

Basic Information

Name *

First

Last

Email Address: *

Phone Number

About You

What is your current weight? *

What is your current age? *

How tall are you? *

What is your occupation? *

Lifestyle Questions

Do any of these apply to you? *

• Pregnant
• Nursing
• Trying to conceive
• None

Do you have any health issues or take any medications that I should be aware of? *

Describe your current exercise routine. *

How many steps do you typically get in a day on average? *

Your Goals

What is your main goal right now? (This will help me calculate your macros) *

• Fat loss
• Maintain weight
• Build muscle (surplus)

Do you know your maintenance calories? If so, what are they? *

Are you currently tracking macros? If yes, what are they? *

Program Details

How did you hear about this program? *

What made you sign up for this coaching? What are you hoping to achieve? *

Would you like to be assigned an accountability partner? *

• Yes, please!
• No, thank you.

What’s your Instagram handle? *

Is there anything else you’d like me to know about you or your journey?

Assumption of Risk and Agreement: Please Read Before Purchase

Checkboxes *

• I agree. Read Here

Phone

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