1:1 Coaching Application
With Candice Kelly Personal Wellness Coaching - for Sustainable Weight Loss
Email *
Name *
Email *
Location (City, State/Country)
Phone number
Weight Loss Goals

Current Weight (lbs/kg)


Goal Weight (lbs/kg)
Describe your weight loss goals in detail
Health and Fitness Background
Have you attempted weight loss programs or diets in the past? If yes, please describe your experiences:
Do you have any medical conditions or dietary restrictions that may affect your weight loss journey? If yes, please explain:
Are you currently taking any medications or supplements? If yes, please list them:
Do you have any allergies or dietary preferences (e.g., vegetarian, vegan, gluten-free)?
Commitment to Change
On a scale of 1 to 10, how committed are you to making sustainable changes in your life to achieve your weight loss goals? (1 = Not committed, 10 = Extremely committed)
What motivates you to seek 1:1 coaching at this time?
Describe any past challenges or obstacles that have prevented you from achieving your weight loss goals.
My coaching services will be at a premium price point, reflecting the substantial commitment I plan to make in terms of time and personalized attention with you during our one-on-one sessions. Are you ready and able to make an investment, not only in terms of your financial resources but also your time and effort, to pursue your goals?
Coaching Preferences
How often would you like to have 1:1 coaching sessions (e.g., weekly, bi-weekly)?
What time of day works best for your coaching sessions?
Additional Information
Is there anything else you would like to share or any specific questions you have for your potential coach?
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