Wellness & Mindset Coaching Application
Hello beautiful human and thank you for being here. Congratulations on taking the first step in changing your life and reaching your goals. I'm so excited to follow you on your personal growth journey. This is a judgement FREE zone. The more open & vulnerable you are with me, the better I can serve you on this journey. I can't wait to hear from you.
Full Name
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First Name
Last Name
IG Handle
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E-mail
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Phone Number (optional)
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Area Code
Phone Number
Location
Country
Rate your mindset
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1
2
3
4
5
Not Good
Amazing
1 is Not Good, 5 is Amazing
How content are you with your current path in life?
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1
2
3
4
5
Not Great
It's Perfect
1 is Not Great, 5 is It's Perfect
Describe your current situation
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What does your dream life look like?
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What could hold you back from reaching your goals? (Finances, Mindset, Outside Support, Etc)
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Anything else you would like to share with me?
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Submit
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