Welcome to your VIP Coaching Application! Here at Dump Your Diet Fitness & Nutrition, we do things differently. This is not a quick fix 90-day transformation, but rather, a whole body, mind, and internal health transformation that goes beyond traditional weight loss. We take a health first approach to any and all goals, including aesthetic goals. This means you not only see results - but you get to keep them. If you’re ready to commit to the ultimate lifestyle change, you’re in the right place! I look forward to reviewing your application!

Section 1: Contact Details & Basic Information

First Name *

Last Name *

IG Handle *

Email *

Mobile Number *

Gender *

Age *

Profession/Job *

Have you worked with an online coach before?

Yes

Section 2: Lifestyle & Goals

Why are you interested in 1:1 coaching for fitness & nutrition? Select any and all that apply.

I want a fitness plan that fits my unique lifestyle, time constraints, and responsibilities

I need accountability to follow through with my nutrition plan and movement goals

I want to improve my overall endurance and athletic performance

I don’t feel confident when choosing food while dining out, due to overwhelm and/or social pressures

I need clarity on what food to eat for my goals, and what workouts fit my goals

Please share anything else that might be relevant. If accepted, what are you hoping to accomplish during our time together?

Think: what are the ‘barriers to success’ that have kept you from achieving these goals and overcoming your day to day struggles?

When was the first time you dieted?

What results have you seen from past dieting experiences?

What have your post-diet experience been? (maintained weight loss for a short period, long period of time, did you gain weight back, etc)

Do you have any known injuries or health diagnoses we should be aware of? (Pcos, Hashimotos, Diabetes, etc)

Section 3: Just a few more questions!

The minimum coaching window for VIP Coaching is 6-mo, but many clients stay on for longer. Industry standard rates for private fitness and functional nutrition coaching starts around a few hundred dollars per month. Are you currently in a position to invest in your health and fitness?* *

If the commitment for VIP Coaching is more than you can invest at the moment are you interested in hearing about other optison such as one-time consults or consultation packages?

On a scale of 1-5, how ready are you to dive into coaching and transform your life?(5 is the highest) *

Is there anyone else involved in the decisions regarding the coaching investment? *

Does your significant other or other involved party know you are applying for and booking a call to speak with me about 1:1 coaching? *

How did you find out about VIP Coaching?

Which current/former client? (If applicable)

How would you prefer me to reach out to you?

I agree to TERMS AND CONDITIONS provided by the company.