Coaching Application Form

This is more than just a health program — it’s a mindset shift, a lifestyle upgrade, and a commitment to doing the deeper work. Please fill out the questions below honestly. This helps me understand where you’re at, what you need, and if this coaching container is the right fit for you.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Age/current weight/height*
Describe your current daily routine (movement, meals, stress, sleep, etc.):*
Describe your relationship with food in a few sentences:*
Why is now the right time for you to commit to coaching?*
What have you tried previously & what were the results?*
What habits or patterns are keeping you stuck right now?*
My coaching is real, honest, and supportive. I give you the tools, but I also call you out when you’re in your own way — with love. Are you open to being challenged and supported in that way?*
What type of accountability or structure do you thrive with?*
Are you open to tracking your nutrition, habits, or workouts to achieve your goals?*
Are you willing to stop the things holding you back in order to get the results you want?*
Coaching is a financial and energetic investment. Are you ready to commit the time, energy, and resources to this process right now?*
If we were talking 90 days from now and you felt proud of your results, what would we be celebrating together?*
How do you currently feel about your body, food, and movement? Be honest — no judgment here.*
What patterns, habits, or thoughts tend to knock you off track the most?*
This program is NOT a quick fix or “perfect plan.” It’s about building the lifestyle that makes the results sustainable. Are you willing to focus on long-term change over short-term results?*
What do you want this experience to feel like day-to-day? (Supportive, empowering, structured, challenging — tell me what you need.)*
What about my style or approach stood out to you?*
How long have you been feeling this way about your health/body?*
When you picture the version of yourself you want to feel like again, what do you miss most — and what do you believe has changed about your body or life since then?*
What would success look like for you outside the scale?*
If we don’t work together, what’s your next step?*
Do you have a support system at home? (Partner, family, roommate, etc.)*
Anything else I should know about you?(Share anything personal, emotional, or logistical that will help me understand how to best support you.)
Yes — I’m ready to start ASAPNot quite
If the answer was not quite- here is why:
If I feel like we’re a good fit, I’ll personally reach out with next steps and program options. Please allow 24–48 hours.
Should be Empty:

This is more than just a health program — it’s a mindset shift, a lifestyle upgrade, and a commitment to doing the deeper work. Please fill out the questions below honestly. This helps me understand where you’re at, what you need, and if this coaching container is the right fit for you.