Stronger Together Coaching Program Application Form
First Name
Last Name
Email
example@example.com
Phone Number (I will only call you in case of emergency)
Birthdate
-
Month
-
Day
Year
Date
Town/State of Residence
How did you learn about the Stronger Together Group Coaching Program?
Reasons for Seeking Strength + Health Coaching
1. .Please share a little bit about your goals. What problems would you like to solve by joining this program?
2. What methods have you tried in the past to achieve certain health goals? Did they work? Why or why not?
3. Briefly describe what you’re doing now to solve your lifestyle challenges?
4. What are your main health and wellness goals you wish to achieve through this coaching program? What would you love your life to look and feel like one year from now?
5. Are there any specific concerns or barriers you foresee that may affect your ability to fully participate in the program?
Rate Your Readiness
I am ready to invest time, energy, and money in myself.
A Stong NO
1
2
3
4
Heck Yeah!
5
1 is A Stong NO, 5 is Heck Yeah!
I believe I can achieve healthy sustainable lifestyle change.
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
I believe that having a coach, plan, and community can help achieve sustainable lifestyle change.
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Tell me one fun/interesting thing about you :).
Is there any other information you'd like to share that you think would be helpful for us to know?
Why do you think you would be a good fit for the Stronger Together Women's Health Coaching Program?
Declaration:
By submitting this form:
I acknowledge that I am interested in joining the Stronger Together Group Coaching Program and commit to making positive changes in my lifestyle.
If I feel that I am not ready for this program after filling out this form, I will cancel my appointment.
If I feel that I am ready, willing, and able to learn more and to see if it is a good fit, I commit to keeping my appointment and give my full attention to our time together.
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