Pre-Application Form | The Habit Shift System

Section 01 of 05

Personal Details

Let's start with the basics so I know who I am speaking with.

Full name *

Email address *

WhatsApp number *

Instagram handle Optional but helpful

How did you find me? *

Instagram

Bark.com

Referral

Other

Section 02 of 05

Health and Medical

Your safety comes first. These questions help me build a programme that is right for your body.

Why I ask this: I am not a doctor, but as your coach I need to know about any conditions or limitations so I can programme safely and effectively for you.

Current age *

Do you have any injuries or physical limitations I should know about? *

No injuries

Minor ones

Yes, significant

If yes, please describe your injuries or limitations Leave blank if none

Do you have any medical conditions I should be aware of? *

No conditions

Yes, managed

Prefer not to say

If yes, please describe Leave blank if not applicable

Have you been cleared by a doctor to exercise? *

Yes

No but no issues

Not sure

Section 03 of 05

Lifestyle and Habits

Help me understand your day-to-day life so I can build something that actually fits around it.

What is your main goal right now? *

Fat loss

Body recomp

Build strength

General health

How many days per week can you realistically train? *

2 days

3 days

4 days

5 or more

How long can you train per session? *

20 to 30 min

30 to 45 min

45 to 60 min

60 min or more

Where will you be training? *

Commercial gym

Home with kit

Home bodyweight

Mix of both

How would you describe your current fitness level? *

Beginner

Some experience

Intermediate

Advanced

How are your sleep and stress levels? *

Good sleep, low stress

Poor sleep or high stress

Both are a struggle

Varies week to week

Have you worked with a coach before? *

No, first time

Yes, it worked

Yes, it did not work

What has been your biggest obstacle to getting results so far? Be honest. This helps me understand how to support you best.

Section 04 of 05

Nutrition and Daily Routine

Understanding how you currently eat and live helps me design something you can actually stick to.

How would you describe your current eating habits? *

Healthy and balanced

Inconsistent

I tend to overeat

I tend to under-eat

Do you track calories or macros? *

Yes, regularly

Sometimes

No

Never tried

Do you have any food allergies or intolerances? List them below or write none

How many meals do you typically eat per day? *

1 to 2 meals

3 meals

4 to 5 meals

Grazing all day

Do you drink alcohol? *

No

Occasionally

Most weekends

Regularly

What supplements do you currently take? Write none if not applicable

Describe what a typical day looks like for you Work schedule, when you eat, when you could train. This helps me find where coaching fits into your life.

Section 05 of 05

Commitment and Coaching Fit

The last section. Tell me where you are mentally and what you are looking for in a coaching relationship.

Describe your goal in your own words. What does success look like for you in 12 weeks? *

Are you ready to start within the next 7 days if accepted? *

Yes, ready now

Almost, need a week

Still exploring

What kind of coaching support matters most to you? *

Accountability

Detailed programme

Nutrition guidance

Someone to talk to

Is there anything else you want me to know before applying? Anything at all. The more context you give me the better I can help you.

What happens after you submit: I will review your application within 24 hours and reach out on WhatsApp to either book a free discovery call or let you know if I think we are not the right fit. Either way you will hear from me.

Apply for Coaching

Application received!