COACHING INTEREST FORM
Name:
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Email:
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Confirm Email:
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Phone:
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Height:
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Current Weight:
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Age:
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Date of Birth:
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Gender:
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Male
Female
Location (State):
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What are your current health/fitness/nutrition goals?:
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What is your ideal program start date?:
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What does your current diet & exercise routine look like?:
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What is your biggest challenge when it comes to nutrition/fitness?:
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Have you worked with a coach before?:
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Yes
No
What type of support are you looking for? (select all that apply):
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Meal Planning
Accountability
Workout Protocol
Weight loss
Weight Gain
Tone & Tighen
Now, in your own words, what is your goal in this program? :
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On a scale of 1-10, how committed are you to making changes? (1-Not Ready at All, 10-Fully Committed):
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Please list any additional comments or information you have that will help us support you better: :
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How did you hear about this program?:
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Instagram handle?:
By submitting this form, I understand that Addison Buesing is not a registered dietitian at this time, but is working toward this credential. All recommendations provided will be based on scientific research and are not a substitute for medical advice. I acknowledge that Fuel, Thrive, Grow: Evidence-Based Coaching does not provide medical nutrition therapy, diagnose, or treat medical conditions at this time. Any guidance provided is for educational purposes only and should not replace medical advice. I understand that it is my responsibility to consult with a healthcare professional regarding any medical concerns related to my nutrition or fitness.:
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I acknowledge & agree
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