Health Coaching Form

The Discovery Call is designed to offer you the chance to meet with a highly experienced Health and Fitness coach who will help you set goals and provide you with support and accountability. To get started, we would appreciate it if you could provide us with some information about your current situation and where you would like to be in the near future.

Full Name

Email *

Phone *

Weight *

Height *

Goal

On a scale of 1-10, how would you rank your overall health right now? *

Out of all the changes you'd like to make, which one(s) feel most important or urgent? *

Considering only the past 4 weeks, what actions are you taking to work toward your goals? *

Health Domains

Which do you think you might need the most support in? *

Medical History

Have you been diagnosed (currently or in the past) with significant medical condition(s) and/or injuries? *

Right now, do you have any specific health concerns, such as illnesses, pain, and/or injuries? *

Are you currently taking any medication? *

What do you expect?

What do you expect from me as your coach? *

What are you prepared to do to work towards your goals? *

Additional Comments/Questions

Commitment

Are you open to monthly reoccurring Health Coaching check-ins with your coach? *

I have read and understand Health Coaching Expectations and Quick Reference Guide