Online Coaching Application Form - Functional Addiction Coaching

Looking to apply to Online Coaching?

YOU MADE IT TO THE RIGHT PLACE, CONGRATULATIONS!

Take a few minutes to complete this short questionnaire. This information will be helpful for us to determine if our coaching is right for you. Please answer everything honestly, there’s no judgement here.

Once you complete the form you’ll be redirected to a link where you’ll be able to schedule your free 20 minute consultation call. I look forward to hearing from you. Talk soon!

Online Training Application Form

Name

First

Last

Gender

Age

Email Address

If you could only eat one food for the rest of your life what would it be? 🙂

What is your current fitness level? (1 is very deconditioned – 10 is extremely fit)

Do you have any health concerns or have you been diagnosed with any illness?

What is your commitment to exercise and training? (1-2 days per week or up to 5, what fits your schedule)

What is your main goal? (Choose maximum 2):

Have more energy

Be stronger

Lose weight

Be free of pain

Reduce your risk to inherited disease tendencies (cancer, heart disease etc.)

Have you ever had a personal trainer, nutrition or online coach?

On a scale from 1 to 10, 1 being “I just want to sit on the couch and eat bon-bons” and 10 being “I’ll eat chicken and broccoli all day, every day if that’s what it takes”, how committed are you to achieving your health and fitness goals?

How much money would you invest in yourself and in your health and fitness journey per month?

If you are human, leave this field blank.

Looking to apply to Online Coaching?

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