Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Which statement below describes your state of readiness (your willingness and ability to reach your goals)

I have too many things going on in my life to commit to achieving my goals.

I’m willing but time will not allow me to make a heavy investment into training. I can still train 2-3x/wk.

I’m willing, and I can commit 3-4 times per week to working out, and ready to make nutritional changes to my diet.

I’m willing, I can commit 4-5x per week to training, and ready to make whatever changes I need to make to my diet

I’m willing and ready to do whatever it takes to reach my goals

How many years have you been training (lifting weights, cardio, etc.) for?

How many years have you been training (lifting weights, cardio, etc.) for?

0-1 year

2-4 years

3-6 years

7+ years

Please check off any of the following exercises you have over 1 year of training experience with. *

Barbell Squatting

Barbell Bench Press

Deadlifting, either conventional or sumo

Overhead Press

Olympic Weightlifting

General resistance training

Do you currently track everything you eat? *

Yes

No

Have you ever tracked everything you eat? *

Yes

No

Are you married or in a relationship? *

Yes

No

Do you smoke? *

Yes

No

Out of the following, which are of highest importance in regards to your lifestyle goals? *

Please select 3-5.

Increased Energy

Increased Mental Clarity

Sense of Community

Improved Relationships

Increased Libido

Overall Happiness

Reduced Stress

Improved Sleep

Improved Nutrition

What is your preferred method of communication? *

Video Call

Phone Call

Text Message

Email

Direct Messenger

How would you rate your confidence going into this coaching experience? *

1 = meh.. 5= It's going to be awesome!

1

2

3

4

5