1. How did you find out about the Coaching Program?
2. Are you applying for Basic or Gold client status?
3. Briefly describe your specific, short-term goals (within the next 16 weeks) with regards to your body and health.
4. Briefly describe your specific, long-term goals (beyond 16 weeks) with regards to your body and health
5. Have you been diagnosed with any health conditions and/or are you currently taking any medications that I should be aware of? If so, please list and explain.
6. If you answered no above, simply type N/A in the box below. If you answered yes, do you have clearance from your physician to participate in a regular exercise program?
7. Are you currently exercising at least three times weekly? If yes, how long have you been consistently doing so?
8. If you answered yes above, simply type N/A in the box below. If you answered no, when was the last time you participated in regular exercise? How long did you participate in the program consistently?
9. How would you rate your current level of fitness? Poor, Fair, Average, Good, or Excellent?
10. Why do you want to be part of the Premium Web-based Coaching program at this time?
11. How important do you feel personal mentoring is to achieving your health and fitness goals? Not Important, Somewhat Important, Very Important?
12. Are you 100% willing to commit your FULL effort to this coaching program over the next 16 weeks?
13. Why do you believe that you will be successful at implementing your programming consistently?
14. Please use the box below for any additional comments.