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1:1 Coaching Interest Form
One on one private coaching is $2000 for the initial 12 weeks. You then have the option to continue in 6 week increments for $500. Please fill out and submit this form if you're interested.
11
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1
Email
*
This field is required.
example@example.com
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2
Name
*
This field is required.
First Name
Last Name
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3
What has been going on in your weight loss journey that brought you here looking for 1:1 support?
*
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4
What is your biggest struggle when it comes to your weight/weight loss right now?
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5
What do you want to achieve in the next 6-12 months?
*
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6
What do you think you need in order to achieve your goals?
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7
What have you tried already? Feel free to share what
has worked
and what
has not worked
so far.
*
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(ie: diets, programs, products, coaching, etc)
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8
How ready do you feel to do the work that I'll be asking you to do during our time working together? physical, mental, emotional, and spiritual work
*
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On a scale from 1-10
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9
If the previous answer was not a 10, what do you feel you need to get it closer to a 10
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10
If you know 1:1 support is the missing key and are ready to invest at least $2,000 in yourself, please choose from the statements below:
*
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I have the financial resources or access to them to invest in myself until I hit my weight loss goal.
I have the financial resources to invest in myself but need to break it up into 2 payments.
I don't have the financial resources but I'm able to make payments using affirm, afterpay, or klarna without it being a financial burden to myself or my family.
I don't have any financial resources at all to invest in myself at this time.
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11
How soon are you looking to get started?
*
This field is required.
Immediately
This month
Within the next 2-3 months
In about 3 months or more
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