MW - 1:1 Coaching Application

Fill out this form to learn more about your goals and to discover if we can work together to achieve them through personalized coaching.

Once you fill out the form with your information (make sure your contact details are correct), I'll be in touch to schedule a free 20-minute Analysis Session (depending on the option you choose).

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Email *
Your first and last name: *
Age: *
Phone number (please add your area + country code) *
Instagram handle:
Best way to contact you: *
Are you:
Clear selection
Gender: *
Do you have kids? *
Are you pregnant? *
If you are currently pregnant, how many weeks?
Have you given birth? If so, what type of birth. *
If you're a mom, please choose any and all of the symptoms that you are experiencing:
Do you suffer from a chronic illness? (Diabetes, hipertension, cancer, arthritis, etc.) *
If your answer is yes, could you elaborate a little on your illness?
Do you take any prescription medication? *
If you take any prescription medication, which one and for what?
On a scale of 1-10, how would you consider your health right now? *
BAD
GREAT
Why? *
What do you do? (mom/dad, sales, teacher, etc.)
What is your stress level currently? *
Zero stress
I'm going crazy
In general, which of these are your goals? Choose all that apply. *
Required
Describe your worries in regards to your health, eating habits and fitness.  *
Of all the ones listed above, which one is the MOST important to you right now? *
Why? *
What do you expect from me as your coach? *
What are you prepared to do to reach your goals? *
Have you tried anything else in the past to reach your goals? *
Which of those things that you tried worked for you before? *
Which of the things you tried DID NOT work for you? *
If you considered making any new changes to your fitness and health, what would those be? *
Up until now, what has stopped you from making those changes? *
How would you rate your eating habits today? *
Terrible
Wonderful
How many hours a week do you exercise? *
What type of exercise do you do? *
How many hours a week do you do other physical activities not related to exercise (cleaning, walking to work or school, repair-work, gardening) *
Who lives with you? *
Who shops for food in your household? *
Who cooks most of the time in your household? *
Today, how supported do you feel by the people around you in regards to your health and fitness?  *
No support at all
Completely supported
How do you feel about your time-management and productivity?  *
My life is complete chaos
My life is calm and relaxed
How many hours do you sleep at night? *
How do you usually manage stress? *
How READY are you to change? *
NOT READY AT ALL
COMPLETELY READY
How WILLING are you to change? *
NOT WILLING AT ALL
COMPLETELY
How ABLE are you to change? *
NOT ABLE AT ALL
COMPLETELY ABLE
How did you learn about Melissa Wellness? *
Required
City and country: *

Throughout the 1:1 Coaching program, you'll gain the information, education, and tools you need to establish healthy habits in your life. As you can imagine, this process requires attention, commitment, energy, and investment, both from you and from your coach, me.

In 1:1 Coaching, you'll receive a personalized program tailored to what you're ready to change, a customized meal plan, personalized exercise routines, and my full attention to guide you towards your goal. This will be a safe space where you'll receive all the necessary resources to achieve your objectives. The program has an initial duration of 12 weeks, and we'll meet via ZOOM for a total of 6 sessions, with weekly communication through WhatsApp or text message.

Here are your investment options:

✨INVESTMENT:

👉 A: One-time payment of $1947 USD (savings of $102 USD) 

👉 B: Three payments of $683 USD


⭐️VIP OPTION (valid only for residents of Katy, Houston, Cypress, and nearby areas)

At the end of your program, you'll receive an exclusive package including professional makeup and hairstyling, image consulting, and professional photographs of your makeover.

👉VIP Option A: One-time payment of $2447 

👉VIP Option B: Three payments of $849

❤️️Are you willing and ready to commit your energy and attention to the program and invest in yourself?"

 *
A copy of your responses will be emailed to the address you provided.
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