Coaching Application Form

Coaching Application Form

This application helps determine if coaching is the right fit. Coaching requires commitment, honesty, and readiness for change. Please answer thoughtfully.
Basic Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth
Date

MonthDayYear
Date
Your Goals & Vision

Primary goal you want to achieve through coaching
How much weight are you hoping to lose (if applicable)
Why is this goal important to you right now?
History & Past attempts - What have you tried in the past?
What do you feel has held you back from success?
Current Lifestyle Snapshot

How would you describe your current routine?
Current Challenges You Face (select all that apply):
Commitment & Readiness

On a scale of 1-10, how committed are you to making lifestyle changes?
What are you willing to change or work on to reach your goals?
Are you open to accountability, honest feedback, and structure?
Coaching Logistics

Preferred coaching format:
Availability for coaching sessions:
Are you prepared to invest time, effort, and finances into your health?
Health Disclaimer (Non-Clinical)

I understand that Sheba's Lifestyle provides non-medical, non-clinical lifestyle coaching. Coaching does not replace medical advice diagnosis, or treatment. I am responsible for consulting my healthcare provider as needed.

Do you agree to this disclaimer?
Why do you feel Sheba's Lifestyle is the right fit for you?
Should be Empty:

Basic Information