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Health Coaching | Your Next Step

Thank you for considering me to be part of your health journey!

This application helps me learn more about you so I can determine if we’re a good fit to work together. There are no perfect answers—I simply want to understand where you are and where you’d like to go!

Your name

*

Your phone number

*

Your email

*

Your Instagram handle

Age

*

Occupation

*

Which areas of wellness would you like to improve?

*

What are your top 1–3 health goals?

*

What’s been your biggest obstacle?

*

Is your faith an important part of your wellness journey?

*

A

Yes

B

No

Would you like biblical encouragement integrated into coaching?

*

A

Yes

B

No

On a scale of 1–10, how ready are you to make sustainable changes?

*

0

1

2

3

4

5

6

7

8

9

10

Why now?

*

What do you hope your coach will help you with?

*

Is there anything else you’d like me to know?

*

Have you worked with a health coach before?

*

A

Yes

B

No