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First name

Last name

Birthday

Month

Day

Year

Over the past few years, what specifically have you tried before to reach your health and fitness goals? (Note, please be specific, such as: Group Fitness, Crossfit, Counting Calories, Keto, Personal Training, etc.)

How did it feel when those attempts didn’t work out the way you hoped? What did work?

What makes now the right time to make a change?

Where do you see your health, strength, and vitality in the next 90 days?

In the next year?

What do you do for work and what does a typical day look like for you? (This helps me understand your stress, sedentary, and wellness levels)

Is there anyone in your life who supports or influences your health decisions? (partner, friend, or coworker)

On a scale of 1–10, how confident do you feel about following through with a plan if it’s the right fit? Why that number?

My coaching style is hands-on, adaptable, and built around what you need—but it does require focus, communication, and consistency. Are you ready for a coach to help lead the way for you?

Yes

Not sure

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Bashista Strength