Coaching Application Form

Before we get into the nitty gritty, let's cover some basics!
What country do you currently live in?*

OtherUnited StatesCanadaUK
Do you currently have a coach for either health/wellness, weight loss, life or business?*

No, I have never worked with a coach.Yes, you are my coach!Yes, I have had a coach in the past, but they are no longer coaching or supporting my journey.Yes, I am actively working with someone.I am a coach.
Awesome! I'd love to learn more so we can have a further conversation.

Let's get some contact information.
What's your first, middle, and last name?*

First NameMiddle NameLast NameSuffix
Date of Birth *
Preferences*

Pronouns?Nickname? If none, write none.
What's your Facebook or Instagram screen name?*
Example Society123 - if none, just write N/A)
Phone Number*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
How did you hear about MCB or her company?*
Okay, now let's get to know you better - and note all your answers on this form are confidential!

Know that it's my goal that we de-stigmatize mental health issues or conditions.
What areas of your life are you the most happiest with right now? *
Do you have any current health conditions or medical issues that I should be aware of? *
Are you currently taking any medications? *
Have you ever been diagnose with a mental health condition? *
Why do you think coaching or a VIP experience will help you right now? It there something that has you feeling stuck or troubled? What is the motivation for seeking help? *
Coaching is a platform to help you live a healthier, happier, more fulfilling life. What would those things mean to you? How ready are you to work on these goals each day?*
Tell me a little about occupation, and either bio family and/or family of choice. Do you like your job? Do you have family support?*
Select the options that best describe why you want to work together NOW!*

I feel stuck, and I'm over it. I need help prioritizing ME now! !Accountability and a positive, supportive coach or community!Flexibility in being coached online or by phone!The chance to participate on a 1:1 VIP Retreat focused only on ME!I want to live a life of purpose. I have big dreams and I'm ready to work hard to make them a reality!
What is the #1 issue you're facing at this time? And what have you tried before to solve this issue? What worked/what didn't?*
On a scale of 1-5, how willing are you to INVEST in yourself and get started today?*
Do you have at least $997 to invest initially in your coaching or VIP experience? *
Now, let's figure out the best way to get you started!

We are almost ready to roll!
What's the best way for us to have an enrollment conversation?*

Call me!OnlineOther
Should be Empty:

Before we get into the nitty gritty, let's cover some basics!

Awesome! I'd love to learn more so we can have a further conversation.

Okay, now let's get to know you better - and note all your answers on this form are confidential!

Now, let's figure out the best way to get you started!