Name

First Name

Last Name

Age

Instagram handle ( optional )

List 1-2 short term goals ( 4-6 weeks )

Don't' be shy, it can be anything: Pounds lost, health, performance goals etc.

List 1-2 long term goals (4-6 months)

Example: improve my relationship with food, be able to bench 200lbs, compete in a bodybuilding competition

Why are these goals important to you?

Example: I want to be able to run around with my kids, fit into my favorite outfit, improve my relationship with food.

Do you currently exercise?

What do you feel is holding you back from your goals?

Check all that apply

Lack of time

lack of motivation

lack of knowledge

lack of accountability

On a scale of 1-10 how ready are you to get started?

Have you worked with an online coach before?

Yes

How did you find me?

What is your favorite food?

Let's pretend calories don't matter for a second :)

Anything else I should know?

Medical issues or injuries?

Last Question

Are you ready to invest several hundred dollars each month to change your life for good?

Yes

Thank you! You should be receiving an email from my within 1-3 days. If you don’t hear from me by then:

1. Check your junk folder. Sometimes application emails land there for some reason.

2. Email me at: trainwithcoachcody@gmail.com