Biblical Health Coaching Interest Form

Biblical Health Coaching Interest Form

Help me get to know where you are at on your journey and how I can help support you 🫶🏼
SECTION 1: Basic Info
Full Name*

First NameLast Name
Email Address*
example@example.com
Age*
For myselfFor my child (I am the legal guardian)
SECTION 2: Current Season
What is prompting you to seek support right now?*
How would you describe your current relationship with food?*
How would you describe your current relationship with movement/exercise?*
Yes, many timesA few timesNoCurrently doing so
If yes, what was your experience like? (Optional)
SECTION 3: Intentions & Expectations
What are you hoping to gain from coaching?*
Yes, that’s exactly what I’m looking forI think so, but I have questionsI’m mainly looking for weight loss
On a scale of 1–5, how ready are you to build habits that you can sustain long term (even if results are slower)?*

1

2

3

4

5

1 is Not ready, 5 is Very ready
SECTION 4: Faith Integration
Very comfortableSomewhat comfortableI prefer minimal faith integrationNot comfortable with that approach
SECTION 5: Health Background
Do you have any medical conditions, injuries, or diagnoses that may impact nutrition or movement?
YesNo
If yes, please explain.
SECTION 6: Investment & Commitment
YesPossibly, I’d like more detailsJust browsing
Why do you feel now is the right time to make a change?*
If the scale never changed, but your energy, digestion, and strength improved — would that feel like progress to you? Why or why not?*
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Biblical Health Coaching Interest Form

SECTION 1: Basic Info

SECTION 2: Current Season

SECTION 3: Intentions & Expectations

SECTION 4: Faith Integration

SECTION 5: Health Background

SECTION 6: Investment & Commitment