Apply For A Call With Fit and Thriving Health
Please complete this brief application to help determine your eligibility and if selected you will get a response within three business days.
Date
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Month
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Day
Year
Date
Name
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Email address
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Phone Number
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Fit and Thriving Health Coaching?
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Are you able to be available between 9am and 6pm PST for appointments?
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Yes
No
Age
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Briefly describe your current health issues and/or symptoms.
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What have you already tried to resolve these issues and/or symptoms?
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How are these issues holding you back from your life, career, and aspirations?
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Why is now the right time for you to address these issues?
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Do you think friends and family will be supportive of you making changes to improve your health?
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Yes
No
If, I am selected and decide to work with you, I’ll find a way to invest in myself and my future:
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I have the necessary means to invest in my health and future.
I have the ability to get the necessary means to invest in my health and future.
I have no financial means to invest in my health and future.
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