New Client Application | Farm Fit Momma

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YOUR 1:1 Coaching Application*

*Limited Spots - Don't Wait!

First name*

Last name*

Best phone number to reach you*

Email Address (will be a priority form of contact for application process)*

Date of Birth*

Month

Day

Year

Were you referred by anyone? or have a referral code? *

What is your occupation?*

Are you a part of the Agriculture Industry? If not, what industry do you work in?*

Business Name*

Are you married? If so, what is your spouses name?*

When it comes to lifestyle change, do you and your spouse handle those together? (if applicable)

**If your application is accepted, and you answered "yes" to the above question, please make sure to schedule a call when your spouse is also available.

Anything we need to be aware of as far as nutrition goes?*

Have you ever worked with a health coach before? (Lifestyle, Personal Trainer, Online Personal Trainer, Mental Health, etc)*

Have you taken any action at all to reach your goals?*

On a scale of 1-5, how important is it for you to overcome your struggles, obstacles, and current mindset to achieve your goals? (1 being least important)*

On a scale of 1-5, how intense are your workouts? (1 - my heart rate does not elevate, 5 - my heart rate is usually high the entire time) *

If we were to work together, what would be the ideal outcome or resolution for you?*

What is the reason WHY you are applying for 1:1 coaching today? *

What is your biggest obstacle you are facing in your fitness journey, right now?*

I operate only from a "HELL YES" in my life, and everything ELSE is a NO. If we should get on a call and it's a HELL YES to work together, are you willing to make the investment in yourself to hire a coach?*

By entering my phone number I consent to receive text messages. I understand I may opt out anytime.