Fit4HealthPlus Coaching Application & Medical Intake
Welcome to Fit4HealthPlus β€” where discipline beats motivation.

This form helps me understand your goals, lifestyle, and timeline so I can recommend the best coaching level for you.

❗️Serious inquiries only I work closely with every client and spots are limited.
πŸ“Œ If selected, you’ll be invited to schedule a strategy call to map out your plan.
⏳ Filing this form does not guarantee a spot effort, honesty, and readiness matter.

Let’s get to work.
Name*
Phone*
Email *
Address
Date of Birth *
Height Feet & Inches*
Weight (pounds)*
Emergency Contact *
Exercise and fitness goals*
Diet and Nutrition Goals*
Motivation to reach my GetFit4healthplus goals *
What has held you back before ?*
Which program are you interested in ?*
Online Self-Paced Program β€” $149/mo
Online Self-Paced + Accountability (Best Seller) β€” $199/mo
Online Self-Paced + Nutrition + Accountability (Elite) β€” $249/mo
Hybrid Online 1:1 Coaching β€” $375/mo or $1,000/3mo
Small Group Training (2–6 ppl) β€” 2Γ—/wk: $325/mo | 3Γ—/wk: $400/mo
Small Group Training β€” 3 Months (Most Popular) 2Γ—/wk: $315/mo | 3Γ—/wk: $350/mo
Small Group Training β€” 6 Months (Best Value) 2Γ—/wk: $278/mo | 3Γ—/wk: $300/mo
12-Week Transformation β€” 1:1 Paid-in-full: $1,800 (save $300) Payment plan: $2,100
6-MonTransfo 1:1 Best long-term value Paid-in-full: $3,600 (save $600) Payment plan: $4,200
VIP 90-Day Transfo (Priority + extra session weekly) Paid-in-full: $3,500 Payment plan: $4,200
VIP 6-Month Transformation (Lifestyle Overhaul) Paid-in-full: $7,000 Payment plan: $8,500
How many days per week can you commit to training *
When do you want to start? (ASAP / 1–2 week*
Budget you're comfortable investing monthly ?*
$149–$249/month
$249–$375/month
$1,800+ Transformation program
How did you hear about us ?*
Social Media Handle*
Has your doctor restricted your activity levels?*
Yes
No
Does your chest hurt during physical activities?*
Yes
No
Have you had chest pain without activity?*
Yes
No
Ever lose balance/consciousness due to dizziness?*
Yes
No
Any body problems that can worsen with activity?*
Yes
No
Any blood pressure or heart condition medications*
Yes
No
Any other reasons for limited physical activity?*
Yes
No
What is your current occupation?*
Does your job require extended periods of sitting*
Yes
No
Have you ever had any pain or injuries*
Yes
No
If Yes, please explain
Does your job require you to wear heeled shoes?*
Yes
No
If Yes, please provide details
Have you ever had any surgeries?*
Yes
No
Please explain if Yes
Has a medical doctor ever diagnosed you with:
A chronic disease
Coronary artery disease
Hypertension (high blood pressure)
High cholesterol
Diabetes
If yes to any, please explain
Are you currently taking any medication?*
Yes
No
If yes, please list
Are you ready to be held accountable? (Yes/No) Do you commit to showing up even when motivation is low? (Yes/No) Would you like coaching that pushes you or coaching that guides you?*
Check the box if true
I understand that results require discipline, consistency, and communication. I confirm the information above is accurate to the best of my knowledge.*
Check the box if true