Health Coaching Application
Apply to work with Brent for advanced health coaching. Please answer all questions thoughtfully.
Name (First and Last)
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First Name
Last Name
Email Address
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example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram Handle
*
What is your primary health goal right now?
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How long have you been dealing with this?
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Please Select
Less than 6 months
6–12 months
1–2 years
3+ years
What have you already tried? For example, GPs, naturopaths, elimination diets, supplements.
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On a scale of 1–10, how much is this affecting your daily life, energy, or performance?
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Not at all
1
2
3
4
5
6
7
8
9
Extremely
10
1 is Not at all, 10 is Extremely
Which best describes your current situation?
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I'm managing symptoms but not getting better
I'm generally healthy but want to optimise and perform at a higher level
Both apply to me
Do you have recent blood work available from the last 12 months?
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Yes
No
I can get it done
What would need to happen in the next 3 months for this investment to feel completely worth it?
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Why do you want to work with Brent specifically?
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Is there anything else you'd like me to know before we speak?
Submit Application
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