Holistic Health Coaching

*Please ensure you are 100% committed to coaching before applying* If you are not sure what plan is best suited for you, please state 'not sure' in the question below and Mitch or Kristin will contact you.
What coaching package are you enquiring for?*

Basic package with KRISTINPremium package with KRISTINBasic package with MITCHPremium package with MITCHComp prep (on or off-season)Self-guided protocolNot sure
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
What do you do for work? Is it physical or sedentary?*
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Age*
Height (in CM)*
Weight (in KG)*
Instagram handle*
What are your 3 main health goals?*
e.g. reduce stress, prioritise my health, reduce weight, build muscle, improve gut health, more structure with my diet, have a better relationship with food, improve self-confidence, work on my self-talk, have a more positive mindset...)
What is your current diet like? - Please be specific - what foods are you currently eating, how many meals per day etc*
What are your current calories? *
Do you have any food intolerances/allergies?*
Do you have any medical conditions? Please be specific - e.g. Diabetes, Crohns, PCOS, Autoimmune etc*
If you are on any medications, please list them.
Please list the foods that you dislike*
What is your sleep like? How many hours per night?*
Do you have children? If so, how many?*
How is your libido like?*

LowAverageHigh
What supplements/vitamins do you currently take?*
How are your stress levels?*

LowModerateChronic
Are you on any drug enhancements/ or have you taken any before? *
What do you do for exercise? (Please include how many days per week)*
This can include: Weight training, walking, yoga, etc
What time of the day do you train?*
Do you have any injuries or limitations?*
Gut health: Do you suffer from any of the following?*

Reflux/heartburnBloating/abdominal discomfortConstipationDiarrheaIBSSIBOCeliac DiseaseNauseaCandida overgrowthNone of theseOther
Lifestyle + Mental: Do you regularly experience any of the following?*

Stress/AnxietyLow self-confidenceNegative self-talkLimiting thoughts/beliefsSelf-sabotagingDepressionPoor relationship with foodNone of theseOther
Do you wake up frequently through the night to pee? *
Do you experience hot flushes or night sweats?*
Do you feel dizzy when exercising?*
Do you experience energy crashes throughout the days? If so, what time of the day roughly?*
FEMALE ONLY: Do you get a regular cycle?
Does it arrive on time? Do you experience heavy or bleeding.. etc
FEMALE ONLY - When is your cycle due?
FEMALE ONLY: Are you on birth control?
FEMALE ONLY: Do you experience sore breasts or aches around your cycle?
FEMALE ONLY: Do you experience stomach pains during ovulation (the lead up) and during your period?*
Do you experience pain on one side of the stomach? If so, which side?
Anything else you would like me to know about your health/lifestyle?*
How would you like to be contacted?*

EmailInstagram
Please allow 24hours for a response. If you are wanting an email response, please keep an eye out in your spam/junk mail aswell.
Should be Empty:

Please allow 24hours for a response. If you are wanting an email response, please keep an eye out in your spam/junk mail aswell.