Name
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What's you biggest wellness goal right now? (Choose up to 2)
Reduce inflammation or heal gut issues
Lose or gain weight in a healthy, sustainable way
Balance blood sugar, hormones, or energy
Build better food habits and feel more in control
I’m not sure yet—I just want to feel better
How important is it for your nutrition plan to align with your faith?
Very important — I want to honor my body as God’s temple
Somewhat important
Not a priority — I’m focused more on science-based strategies
Do you have a diagnosed medical condition that you want to manage through nutrition?
Yes
No
I'm not sure
What kind of support do you want throughout your program?
A coach I can check in with regularly for accountability and encouragement
A structured plan with ongoing education and adjustments
A coach who can help me understand what works best for my body
Emotional support and motivation alongside the plan
What best describes your approach to food?
I believe food can be healing or harmful—I'm ready to change
I’ve tried every diet and I’m tired of the drama
I just need someone to simplify this for me
I’m not sure how to eat for my body anymore
How do you feel about cooking and food prep?
I need simple meals, but I love knowing what’s in my food
I want help finding ingredients and planning ahead
I prefer quick, grab-and-go style
I want to learn how to enjoy healthy food more
What kind of coach are you looking for?
A faith-based coach who can support my wellness and my walk with God
A strategic coach who helps me stay focused and make progress
I’m open to either—just want someone who understands me
How would you like your coach to support you when you hit a challenge or setback?
With faith-filled encouragement and grace
With practical strategies and clear next steps
With a mix of motivation, mindset, and accountability
Which best describes your personality in a coaching setting?
I thrive with spiritual encouragement and heart-centered support
I appreciate structure, strategy, and direct feedback
A blend of both works well for me
How long are you willing to commit to your nutrition journey?
6 months or longer—I want deep, lasting change
I’m open to whatever fits into my life
I prefer to take it one step at a time
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