PREMIER MEMBERSHIP APPLICATION Name * First Name Last Name Email * Phone * (###) ### #### Shipping Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Gender * Male Female Age * Height * Weight * specify pounds or kilos Body Fat Percentage * Do you have access to a gym? If not, what do you have access to? * In detail, describe your exercise history as well as your current exercise routine. * Do you have any current or pre-existing injuries? If so, please explain. * In detail, describe your nutrition history as well as your current nutritional habits. * Are you taking any medications and/or supplements? If so, what are you taking, how much are you taking, and how often are you taking it? * Describe your sleep. How is the quality? The quantity? * Describe your stress levels. * In detail, describe your specific goals. * be more descriptive than "lose fat" or, "build muscle". Why are these goals important to you? * Why have you decided to seek out a coach? What are you expecting out of a client-to-coach relationship? * Are you prepared to invest time, effort, and finances into professional coaching to improve your health and fitness for the better? Explain. * On a scale of 1-10, how committed are you to reaching your goals? * 1 = My significant other is making me do this and I don't give a crap. 10 = This is my top priority. I will do anything to reach my goals. Along this journey, there will most certainly be plateaus and hurdles. Are you prepared to face challenging times? What are your expectations for your this journey? * How many days per week can you workout? * What days of the week work best for you to workout? * What are your hobbies and interests? * Who is your favorite superhero? * How did you hear about Poehlmann Fitness? * Please provide any additional information you think we need to know. Hey there! We know that was a lot of information to fill out. Thank you for taking the time to submit your application. We will be in touch in the next 48 hours. Thanks!
