Coaching Application Form

1

What is your full name?* This field is required.

First Name

Last Name

2

What is your email address?* This field is required.

example@example.com

3

How did you hear about me? e.g. Instagram, Facebook, INDI, Google Search* This field is required.

4

Have you been diagnosed with Irritable Bowel Syndrome (IBS) by a healthcare professional?* This field is required.

Yes

No

5

Please list any medical conditions you have below.* This field is required.

6

Please list any medications or supplements you are taking below.* This field is required.

7

Describe your symptoms below in as much detail as possible.* This field is required.

8

What goal would you like to achieve from 1:1 Coaching & why is this goal important to you?* This field is required.

9

What have you tried before to reach this goal?* This field is required.

10

On a scale of 1 to 10, how much of a priority is it to achieve this goal?* This field is required.

11

I have a high level of success with my clients and want to work with people who are committed & have their goals as a top priority to them. Please tell me why you think you would be a suitable candidate for the coaching programme?* This field is required.

12

The investment for my 1:1 IBS Coaching Programme is 275 euro per month. The minimum commitment is 2 months. Are you in a financial position to make this investment?* This field is required.

Yes - getting IBS control is priceless

No - I am unable to invest in my health goals at this time

13

Is there anything else you would like me to know before submitting your application for coaching?