Coaching application

Remote coaching and consultation request

Please fill out this brief form so that I may learn a little more about how I may help you. As coaching spots become available, you will be contacted to discuss next steps. This form does not obligate you to work with me in any way, this just facilitates conversation so that I can determine if we are a good fit to work together to help you reach your goals.

Name

Date of birth

Where are you located? (must be United States resident)

What is your primary goal to achieve working with Jamie?

Briefly describe your physical activity to include job demands, sport, hobbies and fitness goals.

Why do you think our approach is best suited to help you reach your goal?

Are you currently experiencing any musculoskeletal pain? If yes, briefly describe

Have you had an orthopedic surgery in the last 3 months? If yes, please describe

Please check that you understand that these coaching services are for wellness and preventative purposes. This is not considered physical therapy and will not be reimbursable by health insurance.

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Remote coaching and consultation request

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