First Name *

Last Name *

Phone *

Email *

What is your Age? *

What is your main goal right now?‎ *

Lose weight and tone up

Build strength and confidence

Improve energy and routine

Feel like myself again

What has held you back from reaching your goals in the past? *

Lack of structure or accountability

Time — life gets in the way

I’ve tried programs that didn’t fit me

I lose motivation or consistency

If you had a coach guiding you step-by-step, how would that change things for you? *

I’d finally feel confident and clear

I’d stop starting over

I’d get the results I’ve been chasing

I’d feel supported and accountable

How ready are you to start making changes in your life? *

I’m ready now — I just need the plan

I’m committed, but need accountability

I’m curious and exploring options

What’s your current fitness level? *

Beginner- never trained or more than 6 months ago

Intermediate- train infrequently

Advanced- train 3 times per week

Which part of your body would you like to focus on the most? Please rank your top 3 choices in order of priority. Choose your highest priority first, your second priority next, and your third priority last. You may select up to 3 options. *

Mid Section

Upper Body

Thighs

Glutes

Hips

Legs

How would you describe your energy levels on most days? *

Very low / often exhausted

Up and down

Mostly steady

How would you rate your stress levels right now? (1 = completely calm, 10 = completely overwhelmed.) *

Low (1-3/10)

Moderate (4-6/10)

High (7-10/10)

How would you describe your usual sleep quality? *

Poorly (hard to fall or stay asleep)

Okay (some nights better than others)

Well most nights

 Do you notice any hormonal changes affecting daily life (Painful cycles, PMS, mood swings, perimenopause)? *

Yes, regularly (every month)

Occasionally (not every cycle but commonly)

Not really

Are there any dietary requirements we should be aware of? (vegetarian, gluten-free, dairy-free, etc.) *

Gluten free

Dairy free

Vegetarian

Vegan

None

Any other dietary needs?

How would you like to feel 8 weeks from now? *

how important are these results from 1 - 10 *

BadGood

What would you like to gain out of working with your coach? *

NEXT