Private Coaching Application

I need to gather some information from you to make sure you're a good fit for Private Coaching.

Don't worry, this will only take a few minutes and it's the best way for me to know if I can help you!

What's your first name? *

Nice to meet you! And what is your email address? *

Great! And what's your phone number? *

Are you over the age of 18? *

If your goals include weight loss, how much weight would you like to lose in the next 90 days? *

5-20 pounds

20-50 pounds

50 pounds of more

I'm not looking to lose weight

Please, list any prescription medications you are currently taking: *

What are 3-5 words that describe you best? *

What would you say are your core values? *

On a scale of 1-10, how would you rate your overall life satisfaction? *

On a scale of 1-10, how would you rate your satisfaction with your body? *

On a scale of 1-10, how would you rate your fitness? *

On a scale of 1-10, how would you rate your support system and community? (Family, friends, etc.) *

On a scale of 1-10, how would you rate your overall desire to change your lifestyle? *

Describe your current thoughts and feelings about your day to day life and what you want to improve upon: *

What are 3-5 intentions you have for the next 3-6 months of your life? *

What are 3-5 of the biggest hurdles that have currently been holding you back from those goals/intentions? *

Have you noticed any recurring themes/patterns in your life? What do you feel you've learned from them? Which ones are still showing up? *

Describe your dream life: *

What drew you to working with me specifically? *

Why is now THE time for you to work with a guide/mentor? *

What specific questions do you have about working together before you can make your decision? *

Working with me one-on-one is a 4-figure investment for 30 days. I also offer a self-study program for anyone interested in getting healthy on their own. With that in mind: which of these options feels best for you at this point? *

Thank You!

Your submission has been received!