Coach MP New Client Form

Address

Phone Number *

Area Code Phone Number
I am interested in coaching for: *
Height *
i.e. 5'3
Current Weight *
Please list in pounds
Age *
Are you willing to make permanent lifestyle changes to reach your health and fitness goals? *
What are your long term physique goals? *
i.e. lose fat, gain muscle, find balance, etc.
Have you ever had an eating disorder (diagnosed or undiagnosed)? If so, please explain. *
Do you currently practice flexible dieting/IIFYM? *
What does a typical day of eating look like for you? Please give examples of what you eat daily for each meal. *
Do you currently workout? If so, what types of workouts do you do? *
How often do you workout? *
Where will you be doing your workouts? *
Do you have any physical limitations that would not allow you to do certain exercises? *
Are you currently taking any medicine and/or supplements? If so, please list below. *
Does your significant other FULLY support your decision to make a lifestyle change? *
Please upload current full body pictures in bikini, sports bra and shorts or bra and undies.

Browse Files
Pictures should be taken head to toe. Cancel of
Is there anything else you'd like to share with me before starting your fitness journey?
Should be Empty: