Lifestyle Transformation Coaching with John
Application Form
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Last Name
Email
example@example.com
Phone Number
Age (years)
Occupation
Current Location (City, State)
Current Lifestyle:
I struggle with maintaining a consistent workout routine.
I want to lose weight and improve my physical health.
I struggle with stress or anxiety and want to improve my mental health.
I am looking for a deeper spiritual connection in my life.
I often feel lost or without purpose.
I lack structure and discipline in my daily routine.
I want to break free from unhealthy habits.
I’m seeking a balanced life—mentally, physically, emotionally, and spiritually.
Goals & Motivation:
I’m ready to make serious changes in my life.
I want to incorporate Christ and faith into my personal growth journey.
I want to live a more fulfilling and adventurous life.
I want to build a healthier lifestyle for the long term.
I need guidance to set and achieve my goals.
I feel motivated but need accountability to follow through.
What are your three biggest challenges right now that you hope to overcome with coaching?
What specific areas of your life are you looking to transform (physical, mental, emotional, spiritual)?
Why do you feel like now is the right time for you to start this journey?
On a scale of 1-10, how committed are you to making these changes in your life?
What role does faith or spirituality currently play in your life?
What is your biggest goal in the next 6-12 months?
What do you hope to gain from working with me as your coach?
After reviewing your responses, I’ll reach out to schedule a discovery call to discuss how we can work together and if this program is the right fit for you.
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