DISCOVERY CALL APPLICATION FORM Name * First Name Last Name Email * Phone * (###) ### #### Where are you located? * city and state for time zone purposes How did you hear about us? * Friend Instagram Ad Facebook Ad Google Instagram Influencer If you heard about us from a friend or Instagram page, please write their name or handle below! * we have a referral system in place for our active clients! Age * GOALS * check all that apply Weight/Fat Loss Muscle Building Weight Maintenance Strength Building Lifestyle Change Healthy Food Habits Any history of an eating disorder? * *tracking macronutrients can sometimes act as a trigger for previous disordered eating. While the intention of the program is based in education + support around food the program itself can be very intensive. Sometimes the physical act of planning, weighing, measuring + logging food for an extended period of time can lend itself to unhealthy or obsessive thoughts around food. We always want to protect the mental health of our clients! Have you ever tracked macronutrients before? * YES NO Kind of Have you ever worked with a 1:1 coach before? * Yes No What do you do for work? * so we can map out a plan that's realistic for you and your schedule! What is your #1 long term goal? * Why is "now" a great time for you to start working towards these goals? * How serious and dedicated are you to overcoming your struggles and putting in the effort? * (1 being NOT at all dedicated and 5 meaning VERY dedicated) 1 2 3 4 5 Which best describes your current stage in finding a personal health coach? * Just exploring my options Actively looking but not decided yet Ready to start if this sounds like a good fit Already working with a coach but open to change I understand this call will be full of helpful information and for that reason I will not be driving or multitasking during this time. * Yes No Would this be a joint decision between you and your partner? If so, we'd love it if they could hop on the call as well! * Yes, they play a role in this decision No, this is 100% my decision Thank you! In the meantime, join our FREE Facebook group!
