Counterman Fitness

Coaching Application Form

For driven individuals ready to break through plateaus, lean out and build visible muscle by dialing in nutrition, training and recovery. This is for the people who have tried it all and feel like they are doing everything right, but have little results to show for it. Due to high demand, you must qualify.

Thank you. I received your application and I will be in touch soon.

First Name *

Last Name *

Email *

Phone Number *

Age *

Please note: I do not work with anyone under the age of 21.

List your Instagram handle if applicable

What is your primary goal? *

Be as specific as you can.

What have you been struggling with on your own to achieve this goal? How long have you been struggling with this? *

Your current employment status *

Are you an active service member, reservist, veteran or retired military member? *

Discounts may apply.

Where are you from? *

What do you do for work? *

This helps me better understand your lifestyle.

On a scale of 1-10, with 1 being I am content with my current body and health and 10 being I need to make a change now, where do you fall? *

If the plan fits your goals, are you ready to start right away? If not, pick a time that works for you. *

Date

Time

Pick the day and time you would like to get started.

Where did you find me? *

On the next page, you will be directed to my calendar to book a strategy call with me. On that call, I will walk through your goals and map out a personalized plan designed specifically for your body, lifestyle and long-term success.

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