Fit Mama Online Coaching Form
Hey there Mama!

Welcome to Fit Mama Online Coaching!!!

Please complete this form so that I can get to know you better & help you achieve your goals.

I will set up your program and nutrition report to start for next Monday.


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Email *
Name *
Phone number *
Date of Birth *
MM
/
DD
/
YYYY
Height *
Weight *
Are you currently pregnant, if yes, please provide EDD
What date was your most recent birth? If applicable *
Please briefly describe your birth history
What is your level of exercise ability *
Please list any medical issues that could affect your workout / I need to be aware of:
Do you have diastasis recti? *
Are you able to do squats and lunges? *
Are you able to do high impact moves? (Jumping) *
Are you currently breastfeeding?
Clear selection
How often do you workout? *
How long is an average workout length?
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What type of exercise do you normally participate in?
What is your average workout intensity level?
What are your health and fitness goals? *
Required
What would you say is your biggest obstacle to exercise?
Where would you like to be in 3 months? (Health & Fitness Wise) *
To reach this goal what are 3 things that I will do?
Are there any habits that you would like to start doing?
Are there any habits that you would like to get rid of?
Where would you like to be in 12 months? *
What fitness equipment do you have access to? *
Required
If you selected any of the above, please specify quantity and weight:
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Is there anything that you would like me to know or would be relevant to your training or nutrition program?
A copy of your responses will be emailed to the address you provided.
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