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RFX coaching form
Name
Phone
Email
What is your primary reason for seeking coaching?
Business and career
Confidence
Finances
Fitness
Fun and recreation
Interpersonal relationships
Personal growth
Physical environment
Physical health
Romantic relationships
Spirituality
Please indicate your availability for a Discovery Call to discuss how we can best serve you:
Monday – Friday after 5:00pm EST
Any time on weekends
Sustainable results generally take 6 months or longer to achieve, and our coaching packages start at $1200. This means that coaching requires large time and financial commitments. Are you currently able to make a long-term commitment to coaching?
Yes
No
All coaching programs are fully virtual. This means clients are expected to use a variety of online tools to engage in the coaching process (Google Sheets, Zoom, various apps, etc.). I am either proficient in these tools or am willing to become self-taught on how to use them.
Yes
No
Fitness Coaching Questionnaire
What is your primary reason for seeking fitness coaching?
Please provide your age, height & weight
How many days weekly can you commit to strength training
2 days weekly
3 days weekly
4 days weekly
5 days weekly
Please indicate your equipment access (select all that apply)
Resistance bands
Home gym (less than 200lbs plates/dumbbells total)
Home gym (more than 200lbs plates/dumbbells total)
Commercial Gym
If you currently have access to a commercial gym, please provide the name of the facility
Do you have any injuries or physical limitations?
Yes
No
Are you currently taking any prescription medications?
Yes
No
Which of the following forms of nutrition management have you used previously?
Portion control / mindful eating
Intuitive eating
Weight Watchers
Calorie tracking
Macronutrient tracking
Meal plan
Specialty diet (Keto, Atkins, Paleo, etc.)
Which of the following forms of nutrition management do you wish to utilize GOING FORWARD?
Portion control / mindful eating
Intuitive eating
Macronutrient tracking
Individualized program
Unsure
Do you have any food allergies, sensitivities, or dietary restrictions?
Yes
No
Describe your current relationship with food and exercise
Describe your IDEAL relationship with food and exercise
Do you have a history of disordered eating?
Yes
No
Please indicate your availability for a Discovery Call to discuss how we can best serve you
Monday – Friday after 5:00pm EST
Any time on weekends
Sustainable results generally take 6 months or longer to achieve, and our coaching packages start at $1200. This means that coaching requires large time and financial commitments. Are you currently able to make a long-term commitment to coaching?
Yes
No
All fitness programs are fully virtual. This means clients are expected to use a variety of online tools to engage in the coaching process (Google Sheets/Documents, Google Drive, various apps, etc.). I am either proficient in these tools or am willing to become self-taught on how to use them
Yes
No
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