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Jill HQ Coaching Application Form
This program is designed for women 40+ ready to become stronger, fitter, and fully in control of their body again.

Please answer honestly—this helps us determine if this is the right fit for you.This program is designed for women 40+ ready to become stronger, fitter, and fully in control of their body again. Please answer honestly—this helps us determine if this is the right fit for you.
What is your main goal right now?
- Lose body fat
- Build strength
- Improve energy
- Feel confident in my body again
- Get back into a consistent routine
What’s been your biggest challenge?
- What used to work doesn’t anymore
- I don’t know what to do
- I struggle with consistency
- Low energy / motivation
- Hormonal / menopause changes
How active are you right now?
- Not exercising
- 1–2x per week
- 3–4x per week
- Very consistent
How serious are you about changing this right now?
- Just exploring
- Somewhat ready
- Ready to commit
- I’m all in
When would you like to start?
- ASAP
- Within 2 weeks
- Within a month
- Just researching
If this feels like the right fit, are you willing to invest in coaching?
- Yes
- Maybe
- Not sure yet

Your Company Name

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Address

[email protected]
800-555-0101
yoursite.com

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