Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Age
              
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              Email
              
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              Phone
              
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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, and what did the financial investment look like?
              
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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 
                  
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                    4 
                  
                    5 
                  
                    6 
                  
                    7 
                  
                    8 
                  
                    9 
                  
                    10 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Working with us is a time and financial commitment, ranging between $247-$347/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: