Advanced Health Coaching Application

Health Coaching Application

Apply to work with Brent for advanced health coaching. Please answer all questions thoughtfully.
Name (First and Last)*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Instagram Handle*
What is your primary health goal right now?*
How long have you been dealing with this?*
What have you already tried? For example, GPs, naturopaths, elimination diets, supplements.*
On a scale of 1–10, how much is this affecting your daily life, energy, or performance?*

1

2

3

4

5

6

7

8

9

10

1 is Not at all, 10 is Extremely
Which best describes your current situation?*

I'm managing symptoms but not getting betterI'm generally healthy but want to optimise and perform at a higher levelBoth apply to me
Do you have recent blood work available from the last 12 months?*

YesNoI can get it done
What would need to happen in the next 3 months for this investment to feel completely worth it?*
Why do you want to work with Brent specifically?*
Advanced Coaching is a 3-month minimum commitment at $750/month. Are you ready to invest in that?*

Yes, I'm readyI have some questions about this first.
Is there anything else you'd like me to know before we speak?
Should be Empty: