Coaching ApplicationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Number *Age *Occupation *Health & LifestyleDo you have any current medical conditions or chronic illnesses? If yes, please explain.Are you currently taking any medications? If yes, list them.Do you have any dietary restrictions, allergies or food preferences?What does a typical day of eating look like for you?How often do you exercise, and what type of activities do you do?Do you experience any of the following regularly: brain fog, digestive issues, fatigue, mood swings or hormonal imbalances?Weight & Body CompositionWhat is your current weight? *What is your height? *Do you have a specific weight or body composition goal?Goals and MotivationWhat are your primary health and fitness goals? (e.g., weight loss, mental clarity, energy, strength, etc.)Why do you want to start a ketogenic lifestyle?What has been your biggest obstacle in achieving your health goals?Dieting HistoryHave you tried a ketogenic diet before? If yes, what was your experience?What other diets or programs have you tried in the past, and what were the outcomes?Readiness & Commitment On a scale of 1 to 10, how committed are you to making lifestyle changes? (1= not interested at all, 10= I am willing to do whatever it takes to make a change in my life)(Hint: If you're not at an 8 or above, do not continue with the application) Selected Value: 0 How much time can you realistically dedicate to meal prep and exercise each week?Are you comfortable tracking your food intake and macronutrients?YesNoDo you have a support system at home or in your social circle?YesNoCoaching ExpectationsWhat are you looking for in a coach?How do you feel about receiving feedback and making adjustments to your routine?Is there anything else you'd like me to know about you or your goals?Submit
