Health Coaching Application

Name

Email Address

Phone Number

What are your desired health changes? (select all that apply) What are your desired health changes? (select all that apply) gain energy balance hormones boost metabolism rebuild gut-health eat healthier regulate hunger build muscle loose fat clear skin better brain function improve mindset reduce period pain reverse infertility, endometriosis, or pcos

What health improvement is most important to you?

How would life be different if you were to achieve these health changes?

What have been the barriers in creating these changes for yourself?

How do you feel a health coach will help you achieve your goals?

How much are you willing to invest in this transformation? How much are you willing to invest in this transformation? $0-500 $500-1,000 $1,000-2,000

What questions do you have?

How ready are you to enter a coaching relationship right now? (select all that apply) How ready are you to enter a coaching relationship right now? (select all that apply) I am open-minded about learning new ways of eating, moving, and living I can commit to changes that feel uncomfortable, unusual, or unconventional. I will communicate and negotiate with my health coach as an equal partnership, and feel confident to ask for what I need. I have a high level of self-awareness. I will keep my word to my coach and to myself. I understand that health coaching is an investment in myself, and I will not suffer about the financial cost.