Name
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First Name
Last Name
Email
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Phone
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Are you inquiring about movement/personal training with mindset and/or nutrition integration?
Age, location & job/occupation
Tell me about your exercise history - did you grow up in sports, have any experience in the gym, or are you new to organized movement/working out?
Tell me about your level of motivation and intention behind beginning (or continuing) an exercise routine:
Why do you want to begin personal training and/or mindset coaching?
What goals do you have with your physical body (what you can do with your body/performance or aesthetic).
What goals do you have in other areas of your life (mental-emotional, relationships, financial, career, personal development, etc)?
Have you had a personal trainer and/or mindset coach in the past?
Do you currently have a workout regimen or regularly exercise? If so, what do you do and how often?
Do you have any injuries or health concerns?
On a scale of 1-10, how would you rate your overall mobility/flexibility?
1 being lowest - ex. unable to raise arms overhead, joint stiffness, unable to perform bodyweight squat due to leg or hip tightness. 10 being extremely flexible/hyper-mobile.
On a scale of 1-10, how would you rate your overall strength?
1 being lowest - trouble with stepping up stairs, sitting down and standing up, carrying bags, challenge with every day functions that require strength. 10 being able to lift up very heavy objects, overhead press .5x bodyweight or more, moving with ease through weight bearing movements, etc.
On a scale of 1-10, what degree of body awareness do you have?
1 being lowest - feeling detached from your physical body, poor proprioception, clumsy. 10 being highly aware of your body, in tune with body cues including hunger, bathroom, pain, ease, etc., high proprioception.
Is there anything else you'd like to discuss?
