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EmpowerU 1:1 Fitness Coaching
Application for EmpowerU 1:1 Strength Training, Nutrition, Hormone Balance, and Mindset Coaching
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Email *
First Name *
Last Name *
Email *
Phone Number *
Instagram Handle (or FB Profile Name) *
Gender *
Date of Birth *
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List any current and/or past injuries, surgeries and/or any other medical limitations. If none, write “none”. *
What is your #1 struggle to improve your health, fitness, nutrition, strength, mindset and/or overall well-being? *
What have you tried in the past that hasn’t worked? *
What is/are your current goal(s) related to health, fitness, nutrition, strength, mindset and/or overall well-being? *
What does success look like to you? What would you like to accomplish in the next 6 months? *
Which best describes you? *
How much time are you willing to commit to invest in your health in order to optimize your hormone balance, and to achieve your strength, fitness, and nutrition goals? *
How much money are you willing invest in your health in order to optimize your hormone balance, and to achieve your strength, fitness, and nutrition goals? *
On a scale of 1-10 how committed are you to become EMPOWERED to take control and to find your inner XENA? *
Meh, I'm OK being Edna.
I WANT TO BE XENA!
For fun: What is your walk-up song?
A copy of your responses will be emailed to the address you provided.
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