Coaching Discovery Form

Private Health Coaching With Dr Kpakpo
What's the biggest issue you're facing right now?*

I need more energy to get through the dayI struggle with high stressI want to improve my bodyOther (see below)
If you answered "other" above, what's your most pressing issue?

What's your biggest fear about this problem? Be as specific as you can.

What's your ideal outcome from this problem? Be as specific as you can.*

Are you motivated & willing to make any changes necessary to get this outcome?*

Strongly agreeAgreeDisagreeStrongly disagree

How old are you?*

What do you do for work?*
This helps get an idea about stress levels and what options might be possible to move towards your goals.

What's your name?*

Where do you live? (City & Country)*
This helps us to work out the best times and types of communication.

Are you financially comfortable with investing in yourself to take back control of you health?

If you agree to a follow up conversation, how would you prefer to do it?*

What's your email address?*
Required so we have a point of contact

Would you like a 30min consultation instead of comprehensive coaching?*
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30 minute consultation
$150.00

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