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Coaching Application Form
1 on 1 with Karina V
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First & Last Name
Your answer
Age
Your answer
Phone Number
Your answer
Location
Your answer
Which of my topics can I help you with? Select all that apply.
Fitness
Mindfulness
Nutrition
Lifestyle
Sustainability
What is your number one health concern right now?
Your answer
Where do you need support from me?
Motivation
Accountability/Habits
Knowledge
Routine
Balance
Other:
What does optimal health and wellness look like for you?
Your answer
At what point in your life did you feel your best? And what were you doing to get there?
Your answer
What do you feel is your biggest obstacle to getting where you want to be?
Your answer
Please tell me a little bit about yourself and why you are interested in working with me.
Your answer
What 3 goals (health and life) do you want to achieve over the next 3, 6, or 12 months?
Your answer
What are the 3 biggest changes you want to make over the next 3 years?
Your answer
Please provide any additional information you would like to share before submitting your application.
Your answer
Are you willing to invest in your health?
Yes
No
Clear selection
On a scale of 1-10 how motivated are you to stay dedicated with working together so you can reach your goals.
1
2
3
4
5
6
7
8
9
Clear selection
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