Coaching Application

1

Email* This field is required.

example@example.com

2

Full Name* This field is required.

3

Age* This field is required.

4

Your Pronouns* This field is required.

He/Him/His

She/Her/Hers

They/Them/Theirs

Prefer not to Answer

5

Are you at a point right now where you are ready to COMMIT to changing your health & life?

Absolutely!!!!

Kind of thinking about it

Nope I'm good where I am

Type option 4

6

Which best describes your Most Important Wellness Goal right now?* This field is required.

7

What is the main thing that you struggle with in achieving your goal?

8

What are 3 things you hope I will help you overcome in achieving your goal?

9

Are you ready to stop dieting & buying detox/cleanse supplements?

YESNO

10

Have you ever worked with a fitness/nutrition coach* This field is required.

YESNO

11

If calories weren't a thing, what food/drink would you eat/drink every day with no guilt?* This field is required.

12

Are you prepared to invest $100-$250/month for coaching that could change your health & wellness forever?