1:1 Coaching Application

Bree Rudner - 1:1 Coaching Application

Let's find out if we are great fit for each other...
Welcome!

If you’re ready to support weight loss, navigate the hormonal changes of your 40s and beyond, or boost your energy and vitality, I’m excited to announce that applications for personalized 1:1 coaching and functional testing for the upcoming season are now open!

Please take some time to fill out this form. Once completed, please submit. If you have any questions or would like to talk about the program, please reach out to breerudner@gmail.com.

You will receive an email from me within 24 hours of submitting the application form.

Warmly,
Bree
General Information
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Age*
Gender*

FemaleMaleI prefer not to sayOther
What is your current weight?*
What is your goal weight?*
Occupaiton*
What is your main health goal?Share why you’re reaching out and what you’d like to change or improve in your health right now. The more details you provide, the better! These will become the main objectives we’ll focus on together.*
Goal #1:*
Why is this goal important to you?*
Why is that important to you?*
Goal #2:
Why is this goal important to you?
Why is that important to you?
Goal #3:
Why is that goal important to you?
Why is that important to you?
What are your top 3 goals that you would like me to help you overcome? Please be specific as possible (e.g. lose weight, have more energy, sleep better, reduce hormonal symptoms, build muscle, look and feel better, etc.)*
What are your biggest struggles when it comes to your goals?*

Don't know what to doCravingsEmotional eatingFamily/friends peer pressureOvereatingLack of energySweet toothTime to prepare mealsEnergy crashesFeelings of being 'hangry'Stuck in a rutNot having a planFrequent eating outAlcoholOther
What is stopping you from accomplishing this goal?*
What have diet, nutrition and/or exercise programs have you tried that has not worked?*
What specific health, wellness, and lifestyle changes would you like to make?*
Do you have a medical diagnosis?*

YesNo
Do you currently take any medication?*

YesNo
What is your current activity level? What is your typical exercise routine? Please be as specific as possible.*
Have you tracked your macros before?*

YesNo
What do you REALLY want to achieve by working with me? What amazing things would you like to happen?*
How do you like being coached? Do you prefer a tough love or a warm-fuzzy approach? Something else? What do you respond to best?*
On a scale of 1-5, with 1 being not very ready and 5 being 100% committed, rank your level of readiness with regard to learning new ways of eating and living.*

12345
On a scale of 1-5, with 1 being not very and 5 being very, how committed are you to making changes that feel uncomfortable, unusual, or unconventional?*

12345
Why work with me vs another coach or program?*
What hormonal season are you in?
Are you interested in hormone testing?*

YesNoMaybe
Are you taking hormonal birth control (e.g. pill, IUD, etc.)*
Are you interested in gut testing?*

YesNoMaybe
Is your daily stress level:*

Very highHighModerateLow
How many hours do you sleep each night?*

10 +7-96-75-6less than 5
What time of day do you feel most energized?*
Have you ever engaged in fasting before?*

YesNo
I understand that seeking the help I need from an expert requires an investment in myself — in terms of time, energy, and money.*
What else would you like me to know so I can best serve you?
Thank you!

Please complete the form by clicking on SUBMIT. I will be reaching out to you in the next 24 hours.
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Bree Rudner - 1:1 Coaching Application

General Information