AELEVAR 1:1 CP APPLICATION

1:1 COACHING PROGRAM APPLICATION
This 4-month personalized program is designed for those ready to take intentional steps toward optimal health. With evidence-based guidance tailored to your specific needs and deep-rooted support, you'll break free from old patterns, identify root causes, restore digestive function, and take clear, confident action to regain agency—and finally find harmony in your body.

This application will help us understand your intentions and assess how well this program aligns with your commitment to well-being and achieving personal goals.

Take your time to thoughtfully and honestly answer the questions. After submitting, you can schedule your free wellness consult. During the call, we'll discuss your story, answer any questions, and explore how we can move forward together.

Once confirmed, we'll guide you through the next steps to join Aelevar 1:1 CP.

01. How did you hear about Aelevar's coaching program?*
02. What change do you want to create in your life through this program?*
03. If nothing changes, what challenges will persist?*

04. Six months to a year from now, if you say, "Aelevar's coaching program changed my life", what will have made it true?*
How would you like to see your symptoms (both mental and physical) and life improve over the next six months?
05. What tends to stop you from following through?*
What do you think the physical and mental roadblocks have been?
06. How will you show up fully for this experience?*
When you close your eyes to envision your highest self and life, what does it look like?

Contact Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Ex: 04.30.1986
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Agreements

Please review and confirm each of the following agreements for joining Aelevar CP.
Aelevar Coaching 2025 Agreements*

I understand that health and nutrition coaching is not a substitute for therapy or medical care.I acknowledge that Aelevar CP is a four-figure investment and a 4-month commitment. I understand there is a $200 discount for those who pay in full within 48 hours of their wellness consultation.I am aware that if I choose the monthly payment plan, I commit to four equal monthly payments. I understand the first month’s payment is non-refundable, as it secures my spot in the program.I am ready to commit to my health and well-being and make the investment to secure my spot.I understand that Aelevar 1:1 coaching does not include functional lab testing. Lab testing is available as an optional add-on.I acknowledge that my progress depends on my active participation. While coaching provides guidance, accountability, and support, I am responsible for applying the recommendations and working toward my goals.
This is, and always will be, a safely held space. That said, is there anything else you’d like to share about where you're at-mentally and physically while reviewing your application?
When is your ideal start date?*

MonthDayYear
Date
IMPORTANT

Schedule your free 20-min wellness consultation to discuss your questions and explore how we can work together.

We want to ensure a clear understanding of timelines and expectations. While we do not accept insurance, we do accept HSA/FSA accounts.

If, after reviewing your application, we determine that Aelevar CP is not the right fit, we’ll reach out before the scheduled call.
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1:1 COACHING PROGRAM APPLICATION

Health & Wellness Questions

Contact Information

Agreements