Full Name *

Age *

How tall are you?

Current Weight & Goal Weight *

Which of the following best describes your current goals/challenges? (select all that apply) *

I want to lose fat (lose weight)

I want to build muscle (gain weight)

Improve Performance (strength, endurance, etc.)

I want to improve my overall health, increase energy, etc.

How active are you throughout the day? *

Very light - sitting most of the day

Light - mix of sitting, standing, and light activity

Moderate - continuous gentle to moderate activity

Heavy - strenuous activity throughout the day

What best describes your weekly workouts? *

Very light - almost no purposeful exercise

Light - 1-3 hours of gentle to moderate exercise

Moderate - 3-4 hours of moderate exercise

Intense - 4-6 hours of moderate to strenuous exercise

Very intense - 7+ hours of strenuous exercise

Which best describes your nutrition for the last 30 days? *

What is it you are looking to gain from having a coach?

What is the biggest hurdle you’ve been trying to overcome with your fitness?

What is your commitment level to your personal results?

1. I’m extremely committed. I’m sick of my own bullshit, and I will do whatever it takes.

2. I’m committed enough to invest in my goals but I’m afraid of “missing out” on social events.

3. I know I need help to make a change but I’m not sure if I’m ready to fully commit.

Anything else you'd like to add? *