Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Cell Phone *Email *What’s the best way I can get ahold of you? *EmailTextCallWhat time zone are you in? *How did you hear about my coaching services? *What made you sign up for my coaching services? *Let's learn more about you.When is your birthday?What is your height?What is your current weight? are do to Are you in a relationship? If so, is your partner supportive of your decision to commit to your health?I’m not in a relationship.I’m in a relationship, and they are supportive.I’m in a relationship, but they are not supportive.Do you have children?YesNoDo you have a history of depression or anxiety?Have you struggled with disordered eating in the past?Do you have any dietary restrictions you’d like us to know about?Now, let’s talk about your goals.What are your goals? *If weight loss is your primary goal, how much weight would you like to lose?How do you imagine your life will be better once you reach your goal(s)? What have you tried in the past for fitness and/or weight loss?Why do you believe other programs failed you? What were they missing?How often do you currently exercise for at least 20 minutes? If you’re not currently exercising, that’s okay. When is the last time you did exercise regularly?Which of these statements rings most true for you?You can count on me!Convince me why and I’ll comply.You can’t make me.Discipline is my freedom.We all know that once you set a goal for something important, there are going to be challenges and hurdles to overcome.So to set you up for success, the next set of questions will ask about the challenges that could get in the way.When you tried to lose weight in the past, what were your biggest obstacles?This time, what do you feel are the biggest challenges that could get in the way?On a scale from 0 to 10, how overwhelmed do you usually feel? Selected Value: 00 = Not Overwhelmed at all and 10 = Max OverwhelmedOn a scale from 0 to 10, do you feel like you struggle with being a perfectionist? Selected Value: 00=Not at all 10=Total PerfectionistWhat are some rationalizations you might come up with to quit when things get challenging?Let’s talk about what you’re looking for in a coach, and the coaching style you prefer.Which coaching style do you respond best to?The Partner – helps with friendly, gentle reinforcement.The Drill Sergeant – a direct, no-nonsense approach.The Motivator – delivers encouragement and high energy.The Teacher – explains the rationale and the reasons behind their suggestions.Is there a coaching style or type of feedback that would demotivate you? Why?In the past, what’s the most effective way someone offered you feedback or suggested a way for you to change?Some clients prefer a more structured plan while others prefer a more flexible approach. Which approach would you do best with?Okay, it’s time for a few fun questions.Imagine you’re in line at a bank, and an armed gunman runs in and demands money from a teller. And then just as he’s running out, he fires a shot wildly that hits you in the arm. Everyone else in the room is untouched. Here’s my question…Are you the luckiest person in the world at that moment or the unluckiest person in the world? Why?If you could have one super power what would it be?Okay, just a few more questions.Is there anything you want me to know that you didn’t have a chance to share?Will you commit to reaching out to me if you’re tempted to quit the program? *Submit
