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MidStrong - Healthspan Coaching Application for Membership

Finding the right coach or trainer is a lot like any relationship... it's easy to rush into a bad one, but it can be really messy to get out of. Let's make sure we're the right fit for each other! Please answer the following questions as completely and honestly as possible. Paul or Julie will personally be in touch with you within 24 hours of your submission.

Full Name*

Email*

What Areas Are of Most Interest to You?*

Comprehensive Healthspan Coaching - Nutrition, Functional Fitness, Mindset & Habits

Online Functional Fitness Training

Local (to Westborough) Small Group Training

Nutrition Acceleration Coaching

Something else?

On a scale from 1-5, how committed are you to devote AT LEAST 3 hours each week to your healthspan? *

Mobile Phone *

Age*

City & State*

Gender*

Male

Female

Prefer not to say

How much are you willing to invest in yourself each month to look and feel better than you have in decades?*

What exercise routines or programs have worked for you in the past?

What nutrition programs or diets have worked for you?

Tell me about any injuries or other ailments that might limit your capabilities.

What led you to reach out? Specifically, what do you hope that we can accomplish together?

What's your favorite author, book, or movie?

OK, now let's be honest... what's really kept you from reaching your goals in the past?

On a scale from 1-5, how ready are you to get started right away? *