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Resilient Being Group Coaching Application
This is a 4 week health coaching series, with the option to join for 1 group series or multiple. Fill out this form to see if you would be a good fit for this course, and/or 1:1 coaching with Naushad.
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Email
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Were you referred by anyone? If so, share below.
Your answer
What's the biggest challenge you face with your health and wellness right now?
Your answer
Are you willing to invest the time and energy towards reaching your health goals?
*
Yes
No
Your meeting time availability in PT (mark all that apply)
*
Weekdays at 7:30am PT
Wednesdays at 12pm PT
Wednesdays at 4pm PT
Wednesdays at 5:30pm PT
Thursdays at 12pm PT
Fridays at 12pm PT
Fridays at 3pm PT
Sundays at 10am PT
Sundays at 2pm PT
Other:
Required
What amount of time are you ready to invest in coaching?
*
4 weeks
8 weeks
12 weeks or more
Are you also interested in 1:1 coaching?
Yes
No
Maybe
Clear selection
At what level are you ready to invest financially? This will help us determine what length of program and 1:1 coaching support will suit you best.
*
$500
$1000
$1500
$3000
Health Coaching Interests (mark all that apply)
*
Habit Change & Accountability
Stress Management
Breathwork & Meditation
Mindset
Sleep and Recovery
Mental/Emotional Wellbeing
Eating Strategy
Pain Management
Exercise Program
Detox
Required
Physical Training Interests (mark all that apply)
*
Strength Training
Postural Exercise
Pain Management / Injury Recovery
Flexibility
Yoga
Required
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