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Full Name
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Email Address
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Phone Number
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Date
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Preferred Contact Method:
Phone
Email
Text
What is your top goal?
Fat loss
Muscle gain
Strength improvement
Athletic performance
Accountability & consistency
Mobility & flexibility
Technique improvement
Overall health & longevity
Other
What’s your ideal timeline for achieving these goals?
4–6 weeks
8–12 weeks
3–6 months
Long-term lifestyle change
What motivated you to reach out today?
How would you describe your fitness level?
Beginner
Intermediate
Advanced
Do you currently exercise?
Yes
No
On and off
If yes, what type of training do you do? (Check all that apply)
Weightlifting
Cardio
HIIT
Sports training
Home workouts
Other
How would you describe your current eating habits?
Structured / meal prep
Somewhat structured
Unstructured / inconsistent
Do you have any dietary restrictions?
None
Gluten-free
Dairy-free
Vegetarian / vegan
Other
Rate your daily stress level:
Low
Moderate
High
Rate your daily energy level:
Low
Moderate
High
Which service(s) are you interested in? (Select all that apply)
Personalized Training Program
Virtual Coaching
One-on-One Video Sessions
Nutrition Plan / Meal Planning
Weekly Accountability Coaching
Technique & Form Coaching
Robinson Forge Soundtrack & Motivation
Premium: Executive Athlete Package (“Total Optimization”)
I’m not sure — please recommend a plan
How many days per week are you willing to train?
2 days
3 days
4 days
5+ days
What’s your budget range for coaching? (Optional)
Under $100
$100–$250
$250–$500
$500–$1,000+
Not sure yet
Select a Choice
First Choice
Second Choice
Third Choice
Is there anything else Coach Robinson should know before recommending the right program for you?
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