Nutritional Coaching Inquiry Form - JMelitefit.com

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THE TIME HAS COME!
Applications are officially OPEN and we are now expanding the J&M client roster!
We couldn't be MORE excited to help all of you.
Please fill out the following inquiry form to apply for NUTRITION ONLY coaching.
We try our best to respond to any and all inquiries
within 72 hours.
Not ALL inquiries will be accepted!
Acceptance subject to availability, time, and fit.

* Indicates required field

Name *

First

Last

Email (please use the email you want to use for weekly contact!) *

YOUR Cell Phone Number *

Where do you live? (state and/or country) *

EMERGENCY Contact Number *

How did you learn about J&M Performance, or Mel Z Fit and our Online Coaching Plans? *

Internet Search Advertisement Friend Current or Past Client Instagram/Facebook Other

If you were referred by someone please type their name below: *

Are you filling out this application for yourself or for someone else? (ex: your child/spouse/friend) *

For myself My child My spouse Other

What is your current age? *

Less than 13 13-18 19-25 26-35 36-50 Over 50 Prefer not to say

How active would you say you are on a daily basis? *

Very Active (mostly moving job, rarely seated) Slightly Active (a combo of moving and then seated) Slightly Inactive (I do more sitting than standing but make time to move a little) Sedentary (mostly seated all day, very little activity

Experience with nutrition/food/dieting (check all that apply) *

Dieted on and off for years Never tried a diet, I eat whatever I want Poor relationship with food Binge eating Eat healthy sometimes, then really unhealthy other times I lack consistency I don't know what is "healthy" I don't know what I should be eating

in detail, what has been your biggest challenge when it comes to accomplishing your health goals? *

What type of plan do you feel would best suit your lifestyle? *

Flexible - make the foods I love work for my goals Strict - give me a plan to follow and I'll do it! Intuitive- feedback and guidelines to follow but no rigid plan A Combo- maybe a little of all

Tell me a little about your current workout or exercise routine? (walking, gym, movement, etc.) *

Favorite Foods? (any and all) *

Do you own or use a fitness tracker of some kind? (Fitbit, apple watch, etc.) *

Yes No Will purchase one

How much water do you drink in a day? (actual water) *

What are you goals? What do you hope to accomplish with your health and fitness? Be specific! I want any and all of them! Everything is tied into health! *

Body change I want to achieve (check all that apply!) *

Weight Loss (just lose sizes and inches) Fat Loss (all over or specific areas) Muscle Building (increase muscle mass) General Health (feel great, more energy, etc) Performance Based (sports, athletics, work, life)

Any health/medical conditions, diseases, or issues we should know about? *

Please check any that relate to you *

My doctor told me I had to lose weight for my health I have diabetes or pre-diabetes I want to prevent any conditions before they develop I want to improve my physique and be healthier None of the above apply

Tell us all about YOU! Anything else we should know? *

What is your WHY (your reason for wanting to be a better you) *

**Inquiry forms are typically answered within 72 hours.
Please be patient, you will hear from us soon!

I agree to receiving marketing and promotional materials

Let's DO THIS!!

DISCLAIMER: JMELITEFIT.COM is not subject to any liability due to injury sustained during use of any programs or products sold on this website.
Please exercise with caution and know your physical limitations. Ask if you have any questions.

CONTACT US: michellemelzl@yahoo.com

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Home
SHOP
Become a Member
Testimonials
Member's Portal
Online Coaching
Meet the Coaches
- Instagram
Contact
Health & Fit Blog