Coaching Questionnaire

Let's see if this is a good fit.

This application is for individuals with autoimmune or chronic conditions who are serious about improving their health, fitness, or physique in a sustainable, long-term way.

My coaching is structured, highly individualized, and designed for lasting results. This is not a quick fix and it is not for everyone.

If that sounds like what you're looking for, please continue to the next page. The application takes about 5 minutes to complete.

If your responses indicate a strong fit, you’ll receive an email within 48 hours outlining next steps.

To confirm — you have an autoimmune or chronic condition and you’re looking for structured 1:1 coaching to improve your health, fitness, or physique in a safe and sustainable way that supports your long-term health. *

Yes - that's me

Yes, but I’m still exploring whether coaching is right for me

I'm just browsing

Full Name *

Which of the following best describes your primary goal right now? *

Lose body fat in a way that supports my health

Build muscle and strength

Improve energy, resilience, and overall quality of life

A mix of the above

I'm not totally sure, but what I'm doing now isn't working

What makes you interested in working with me specifically? *

I want a coach that doesn't just know fitness but also understands living with a chronic illness

I'm looking for something that balances results with recovery - I want someone who will challenge me without pushing me into a flare

Your clinical background makes me feel more confident

I'm mainly interested in the results you talk about

Please list any autoimmune or chronic conditions you have, along with any other health concerns that may impact training. You can keep this brief. *

How would you describe your current health status? *

In remission or mildly active disease - symptoms are generally manageable

Moderately active disease - I function but symptoms do affect my daily life

Unstable or severely active disease - recently hospitalized, or my symptoms severely limit my ability to function

If requested, are you willing to obtain written medical clearance before starting? *

Yes

Are you currently in need of physical therapy, hands-on rehabilitation, or supervised medical care to exercise safely? *

I am working with a provider but cleared for independent training

Yes, I require hands-on rehab or supervised medical care

This is a highly specialized 1:1 coaching program designed specifically for individuals with autoimmune and chronic conditions. It begins with a 6-month commitment and includes personalized programming and direct, ongoing support. I intentionally limit the number of clients I take on to maintain a high standard of coaching. If we both feel it’s a strong fit, are you prepared to make a meaningful financial investment? *

Yes

Possibly, depending on details

Not at this time

Assuming we both feel it's a strong fit, when would you realistically be ready to begin? *

Within the next 2 weeks

Within the next 4 weeks

I'm not ready to start in the next month

Do you make personal and financial decisions independently? *

Yes

I typically discuss larger decisions with my partner

I would need my partner involved in the decision

Email *

Mobile Phone *

AK Health & Fitness