INSIDE OUT Program Application

INSIDE OUT Program Application

Before starting this application, please make sure you’ve visited www.stretchreset.com/insideout and have a basic understanding of what the program is about. The application below helps us determine if we’re the right fit to work together. I partner with clients who are ready to take ownership of their growth and create meaningful results. If that sounds like you, go ahead complete the application — and let’s begin your journey toward lasting transformation. ONCE YOU COMPLETE THIS APPLICATION you’ll be taken to my website to schedule your free 30-minute consultation call to go over the program details, discuss rates, payment options, and any questions you may have
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
When is your birthday?

MonthDayYear
Date
Best way to contact you:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you heard about me?
WHO are you? Write down 3 words (only 3 words) that describe yourself as TODAY. Close your eyes, take 3 deep breaths and don't over think, just write down the first 3 words that come to your mind. It can be complex or simple words but please avoid to write down your Name. (Ex. Dad - Anxious - Sports / CEO - Lesbian - Republican / Animals - Hispanic - Exhaustion)
Define LOVE. Please don't google it, just write down first thoughts when you think about the word: LOVE. It can be a sentence, a phrase, or randoms words.
What brings you to INSIDE OUT? What are you trying to achieve or fix with this program?
Have you ever had any mental health treatment from a counselor, coach, therapist, or psychiatrist? If yes, please give a brief history of your mental health treatment and the results of your treatment:
How long have you had this issue/problem(s)?
What other methods have you tried to resolve these problems?
Why do you think INSIDE OUT is a good program for you?
What is currently your most important life goal or ambition?
Do you follow any religious or spiritual practices? If so, please describe briefly.
Please use the area below to add any further thoughts or information you think may be helpful or relevant in any way.
If you are accepted into this program, will you be willing to commit the time, effort and energy, a program of this caliber requires and be an active participant in the transformation process? Keep in mind this is a 60 days program, 8 Coaching Sessions/ 1 per week. 3 One on One Physical Training Sessions 1 every 4 weeks. Also, you need to commit to practicing your physical training routine/homework for 1 hour each day, at whatever time suits you best.
To be more successful in reaching my goals, I agree to: (required) 1: Be an active participant and see myself as a partner in the transformative nature of this process. 2: Recognize that my thoughts, feelings, images, and actions have a direct effect on the quality of my life. 3: Acknowledge that my well-being depends directly on how well I care for myself physically, emotionally, intellectually, and spiritually. 4: Accept that blaming others or myself is futile. 5: I agree to be on time for my sessions and allow at least 24 hours advance notice should I need to cancel or reschedule a session.
Should be Empty: