Let’s work together.

Hi! I am so excited to chat with you. The purpose of this application is to help us to get to know you better. Once you finish the application, you will have the opportunity to book a FREE 15-minute discovery call.

Name

First Name

Last Name

Phone

(###)

###

####

Tell me a more about your current health goals? What do you hope to achieve while working together?

How long have you been trying to reach your goals?

What is your biggest challenge you are facing when it comes to reaching these goals?

On a scale from 1-10 how serious are you when it comes to reaching this goal?

1 = Not Serious at All, 10 = Very Serious

Have you worked with a personal online functional health coach before?

Yes

The purpose of this consultation is to determine if this program is a good fit for you. if we do determine that is the case, are you able to invest your time, energy, and financial commitment?

I have the finances and energy to invest in my personal growth, health, knowledge and performance

I am willing to invest if I believe in the program and accountability can deliver results

I am not in a place where I can invest in my personal growth, health, knowledge and performance at this time

Does your spouse or significant other support you? (meaning they will give you the thumbs up with whatever you decide?) If you are single just say yes.

Yes, they are supportive

No, I am not sure if he/she does support me