midlifebooking.com -

Consultation Form

First Name

Last Name

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date of Birth (MM/DD/YYYY)

Occupation

Have you been diagnosed as being in perimenopause or menopause?

What specific symptoms are you experiencing related to menopause?

Do you exercise regularly? If so, how many times per week and how long?

What type of physical activities do you enjoy? (e.g., yoga, running, weightlifting)

If you said had a response to the last question, what was that experience like?

What are you looking for in a coach? (e.g., accountability, motivation, expertise in nutrition)

What are your fitness goals? (e.g., build strength, increase endurance, flexibility)

What has prevented you from achieving your fitness goals in the past? (e.g., time constraints, lack of motivation)

What is your annual income? This response is optional.

Are you willing to make the necessary changes to become your best self?

What do you hope to achieve through working with a fitness coach?

Is there anything else you would like to share that may help in creating your personalized plan?

Select Appointment Date & Time