Welcome to Eliteman Coaching!

Thanks for your interest in working with us.

In order for us to provide you the best information possible, we need to learn more about you and see how we can help. Please fill out the form below as best as you can!

*Note: Only 5-10 spots are available each month to join our program. We believe in providing a high level of quality to our clients to maximize results and client satisfaction.

THIS PROGRAM IS NOT FOR ANYONE:

• Under 18 years of age.
• Unemployed or financially unstable.

Please only fill out the application if you are serious and want life changing results.

Name *

First

Last

Email *

What is your age? *

What city/town do you live in? *

What are your personal barriers regarding weight loss and/or exercise? *

How long have you been struggling with this for? (e.g number of years/months) *

What is you number 1 primary fitness goal you'd like to accomplish? (Please describe in detail) *

Are you currently working out? *

On a scale of 1 (being lowest) and 10 (being highest) how important is it for you to achieve results? *

WHY is it important for you to make these changes TODAY? *

Are you at a point where you are ready to commit to your fitness goals right now? (within a week*) *

Do you train in a gym facility or home gym? *

• Home Gym
• Gym Facility

If you train at home what kind of equipment do you have available for use?

How did you hear about us?

As a coach, I deeply value and respect your time. If I schedule a consult call with you, can you commit to showing up at the scheduled time for our call, fully present without distractions? *

• Yes
• No

Anything else you'd like to add?

Submit