APPLY TO WORK WITH ME:

The application should take about 5 minutes to complete. Please have a few current progress pictures ready to include as well. Should this page give you any technical issues you can also reach out via email for a text version

EMAIL : Katie@BreakTheCycleFit.com

CLIENT APPLICATION

Full Name

Birthday

Month

Day

Year

Weight

Height

City/State OR Country if outside USA

Do you currently work or go to school? What is your field or area of study?

How familiar are you with counting macros or calories?

Not at all

Some

Very familiar

Have you worked with a coach or trainer before? If so what you you like or dislike about past coaching?

How often do you get take out, have family meals or other occasions where you don't prep/cook yourself?

How often do you consume alcohol?

Please list all vitamins, supplements and any other NON prescription items you use regularly

Please list all PRESCRIPTION or medically recommended medicines as well as the treating conditions for each.

Please list all relevant medical conditions, surgeries and / or dietary restrictions.

How many years' weight training experience do you have?

None (Beginner, 0 experience)

A Few Years (Moderate)

A Decade or More (Experienced)

Assuming you're provided a detailed program, how comfortable do you feel in the weight section alone?

Do you have any other athletic or performance goals/ events we should consider and prep for? For example powerlifting meets, being an offseason physique competitor, marathons or 5k's, biking events, etc.

Realistically, can you commit to getting to the gym for about an hour 3-4 days per week for the next few months? If not, what issues do you foresee being in the way to that?

Would you say you generally sleep well, get adequate sleep and feel well rested?

Do you feel like your relationship with the scale, food and or appearances is one that brings you regular stress or anxiety?

What do you anticipate could be the most likely factors to discourage you, tempt you to stray from the plan or regularly deviate from your goals?

What is something not addressed by this application which you feel important to either understanding you as an individual , or your needs as far as programming?

What is your biggest motivation to change your diet, physique or eating habits right now - why now, and what is your biggest driving force to make these changes?

Finally, please attach three current pictures. You MUST show your face (I want to get to know the person I’ll be training). Swimsuit equivalent coverage is recommended. These pictures are visible only to myself and never shared.

2-3 Pictures are encouraged for accurate assessment

By submitting this application I agree to all of the Terms & Conditions as detailed here.