Name
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First Name
Last Name
Age
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Email
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Phone
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(###)
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Are you struggling with an active eating disorder? If yes, I am unable to work with you as that’s outside of my scope of practice. I am happy to provide you with professional eating disorder, mental health, etc. resources if you wish.
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Why NOW? What motivates you to start coaching?
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Tell us a little about yourself (work, lifestyle, hobbies, etc.)
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What are you currently doing for your fitness and nutrition goals?
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What is your familiarity with tracking calories/macros?
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I've never tracked before, but I'd like to
I've tracked in the past
I currently track my macros
I don't want to track my macros
Tell me a little bit about your relationship with food and exercise
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Have you ever worked with a nutrition coach before? If so, how was that experience?
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What are the health and fitness goals you want to achieve with A-Hub Nutrition?
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What is currently working for you and what is currently keeping you from reaching your goals?
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On a scale of 1-10, how ready are you to commit to reaching your goals?
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1
2
3
4
5
6
7
8
9
10
Which program are you interested in?
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1:1 Nutrition Coaching
One Time Consultation
Working with us is a time and financial commitment, ranging between $200-$350/month depending on the package. Are you in a position to invest these resources in your health?
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Yes, I'm ready to start now!
I cannot invest at this time
How soon are you looking to start?
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I was ready yesterday!
In a couple weeks
I'd like some more information first
You can put anything else you'd like us to know or questions you have below: