Strengthen- Lifestyle Coaching Program
My purpose: The purpose of this pre-registration form is to help me better understand your challenges and to  what you need to take your health and fitness to the next level and beyond! Ready, Let's Go!
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A Woman of Faith, Strength, & Moderation
Name *
Email address *
Phone Number *
1. What are you looking for in a health and wellness coach? *
2. What are your health (nutrition, fitness, and wellness) goals for the next 6 months? Please Be Specific *
3. On a scale of 1 -5 how important is it for you to reach these goals? (1 not important, 5 very important) *
4. What are/were your current challenges you face when it comes to reaching your goals? *
5. What have you tried, if anything, at this point to move in the right direction for your health and body goals? (Such as: keto, paleo, HIIT exercise, kick boxing, walking, medical weight loss, etc) *
6. What are 3 successes to date? Doesn't have to be related to health.
7. How happy are you with your current nutrition habits right now? (1 not important, 5 very important) *
8. How happy are you with your weight right now? (1 not important, 5 very important) *
9. How happy are you with your life right now? (1 not important, 5 very important) *
10. What changes with your health would make you happen right now? *
11. How soon are you ready to start Breaking The Chains over your current situation? Specific Date, time, day, etc. *
12. What days and times are a good to follow up with you by phone the program? *
Required
13. Lastly, What is your WHY? Be very specific and truthful with YOURSELF. (What is your reasoning for completing this form? I want to know the bigger picture.) *
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