Coaching Application Form

Hello beautiful soul!

I just need a bit of information from you so we can start healing and working together!  This is a serious commitment.

Before we can start on our long & exciting journey together, let’s figure out if we are a fit AND let’s see if I can help you.

I wouldn’t be a legit coach if I didn’t ask you a few questions first.

Simply jot down these questions into your notes app of your phone and once finished email them back to me.  In the email, subject write: COACHING APPLICATION FORM.

NAME:

AGE:

EMAIL ADDRESS:

PHONE NUMBER:

ADDRESS/STATE:

HOW DID YOU FIND OUT ABOUT ME?

WHY ARE YOU SEEKING COACHING?

ARE YOU LOOKING FOR HEALTH + NUTRITION COACHING OR SPIRITUAL + MINDSET COACHING?

DO YOU HAVE A SUPPORT SYSTEM?

ON A SCALE FROM 1 – 10 HOW IMPORTANT IS IT TO HEAL YOUR BODY?

ON A SCALE FROM 1 – 10, HOW READY ARE YOU TO START NOW?

WHAT DO YOU SEE YOURSELF ACCOMPLISHING AS A RESULT OF COACHING?

ARE YOU WILLING TO BE A TEAM PLAYER IN YOUR OWN HEALING?

ARE YOU READY TO SHOW UP FOR YOUR BODY AND COMMIT TO THIS TYPE OF HEALING?

HAVE YOU EVER WORKED WITH A HEALTH COACH BEFORE?

DO YOU HAVE CELIAC DISEASE?

DO YOU HAVE A GLUTEN-INTOLERANCE OR GLUTEN-SENSITIVITY?

HAVE YOU BEEN TESTED FOR CELIAC DISEASE? IF YES, PLEASE EXPLAIN:

HOW LONG HAVE YOU BEEN GLUTEN-FREE?

DO YOU HAVE AN AUTOIMMUNE DISEASE? IF YES, PLEASE EXPLAIN:

DO YOU HAVE CHRONIC HEALTH CONDITIONS? IF YES, PLEASE EXPLAIN:

DO YOU HAVE CHRONIC ILLNESS?  IF YES, PLEASE EXPLAIN:

HAVE YOU EVER BEEN ON AN ELIMINATION DIET BEFORE?

WHAT DOES YOUR DIET LOOK LIKE ON A DAILY BASIS?  PLEASE LIST A 5-7 DAY FOOD JOURNAL.  BE HONEST AND RECORD IT ALL.  BREAKFAST, LUNCH, DINNER, SNACKS, DESSERT AND TIME FRAMES.

DO YOU HAVE ANY FOOD ALLERGIES?  WHEN WERE YOU DIAGNOSED?  AND BY WHAT METHOD?

DO YOU HAVE ANY FOOD SENSITIVITIES?  WHEN WERE YOU DIAGNOSED, AND BY WHAT METHOD?

DO YOU HAVE ANY VITAMIN OR MINERAL DEFICIENCIES?  IF SO, WHAT ARE YOUR LEVELS, LIST THEM HERE:

WHEN WAS THE LAST TIME YOU HAD ROUTINE BLOOD WORK?

LIST ALL SUPPLEMENTS, MEDICATIONS, AND DOSAGES BELOW THAT YOU TAKE:

ARE YOU ON ANTI-DEPRESSANTS OR ANTI-ANXIETY MEDICATION?  PLEASE EXPLAIN:

DO YOU HAVE MYSTERY SYMPTOMS YOU CANNOT FIGURE OUT?  PLEASE EXPLAIN:

WHAT IS YOUR CURRENT OCCUPATION AND WHAT ARE YOUR HOURS ON A TYPICAL DAY?

ARE YOU INTERESTED IN HEALTHY GLOW PACKAGE 3 MONTHS, AWAKENING PACKAGE 3-MONTHS, OR REBIRTH PACKAGE 6 MONTHS?

ANYTHING ELSE YOU’D LIKE TO ADD?