PROFX: Peak Performance Coaching

First Name *

Last Name *

Phone *

Email *

Please select your coach: *

How did you hear about us? *

What's your Instagram handle? *

Date of birth *

Identify your TOP 3 goals for the next year that you need help with (Be Specific): *

Identify your main frustrations: *

Tell me something unique about yourself: *

How would you describe your follow-through history? If you don't have a good track record here, what has gotten in your way previously? *

How would you describe your habits and routines (Select one) *

Healthy, consistent, highly productive, and efficient

Mediocre

I haven't really established and good habits or routines

I have a lot of poor habits and don't have a routine in line with my goals

Do you have any time management strategies in place? *

Yes

No

I could improve

What would you say are your biggest distractions that deter you from focus, and decrease your productivity and efficiency? *

Do you tend to have self-limiting beliefs, or let others achievements put a ceiling on what you believe you can achieve? *

What is your biggest hurdle with achieving your health and fitness goals? (Select all that apply) *

What are you seeking in a coach? *

Are you willing to make changes to become the highest version of yourself? *

Yes

No

Are you the primary decision maker in your household? *

Yes

No

Are you currently willing to make a significant financial investment in yourself? (Select one) *

Yes, I have the cash flow to invest

Yes, I may or may not have the cash flow but I have access to credit

No, I do not have cash flow and I have no access to credit

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