Balanced Imperfection Fitness & Nutrition Coaching Application

Thank you for your interest in joining Balanced Imperfection!💪

We’re excited to learn more about you and how we can support your goals. Once you submit your application, we’ll reach out via text within 24 hours to connect and set up a free consultation call!

Full Name *

Phone *

Email *

IG Handle

Time Zone *

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What are your current health & fitness goals? *

What has been your biggest challenge(s) in reaching these goals? *

Have you tried anything in particular in the past to reach these goals? *

On a scale of 1-5, how ready are you to reach these goals? (1 being "not ready at all" and 5 being "I need to make this change now")

1- I could put this off for awhile

5- I need to make this change now!

What is your occupation and how much stress do you bring home, on average? *

Would this be a joint decision between you and your partner? *

Yes, they play a role in this decision

No, this is 100% my decision

Not applicable

If we are able to come up with a plan in terms of enrollment fees and reaching your goals, are you ready to make an investment in your health & fitness? *

YES! I am willing to make the investment to reach my goals with both accountability and structure from a coach. This is a serious, long-term change for me to reclaim my health and happiness.

I am unsure if I can financially invest but am happy to work with you on program / payment options so I can make a decision by the end of our call

I am not financially stable to invest in myself or in my goals / it's not a huge priority right now.

If we determine coaching is a good fit, how soon are you looking to get started with your program? *

How did you hear about us?