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Online Coaching Sign Up Form

Section 1: Personal Details

First name*

Last name*

Email*

Phone*

Birthday*

Day

Month

Year

Address*

Occupation*

Do you have any children? If yes, how many and ages?

Section 2: Goals

What is your main goal right now? (eg fat loss, strength, confidence, routine, energy)*

Why is this goal important to you?*

If we fast forward 3 months, what would success look like for you?*

On a scale of 1-10, how committed do you feel right now?*

Section 3: Current Lifestyle

How many steps do you roughly do per day?*

How many days per week can you realistically train?*

How long do you have for each workout?*

How would you rate your sleep?*

Poor

Okay

Good

Stress Levels Currently:*

Low

Moderate

High

Section 4: Training Experience

Have you trained before?*

Yes

No

If yes, what have you done previously?

Do you currently train?*

Yes

No

What do you enjoy (if anything) when it comes to exercise?*

What do you not enjoy?*

Do you want your workouts to be based in:*

Gym

Home

Both

Equipment available (tick all that apply):

Dumbbells

Kettlebells

Long Resistance Bands

Short Resistance Bands

Barbell

Machines

Other

Section 5: Barriers and Mindset

Where have you stopped reaching your goals before?

What do you struggle with most right now?*

Consistency

Motivation

Time

Confidence

Nutrition

Other

What usually happens when you fall off track?*

What do you feel you need most from me as your coach?*

Section 6: Nutrition and Habits

Do you have any dietary preferences?*

What does a typical day of eating look like for you? (no judgement - just helps me guide you better)*

How would you describe your relationship with food?*

How often do you eat out / order a takeaway?*

Section 7: Expectations

What does your "ideal" coaching experience look like?*

How do you prefer to be supported?*

Encouragement

Accountability

Education

Other

Are you happy to check in weekly on a Sunday? (will be reviewed on Mondays by Emily)*

Yes

No

Section 8: Commitment

I understand that results come from consistency, not perfection*

Agree

Disagree

I agree to give 28 days notice in order to terminate my online coaching.*

Agree

Disagree

I can confirm that all of the information provided is accurate to the best of my knowledge.*

Agree

Disagree

I understand that I am responsible for informing my coach of any changes to my health.*

Agree

Disagree

I agree to the terms in the coaching agreement (attached to bottom of this form)*

Agree

Disagree

Section 9: Final

Is there anything else you'd like me to know?

Signature*

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Click here to view the online coaching agreement

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