Tell Me About Yourself
After you fill out this form, I will contact you with details and availability before the program begins. If you would like faster service and direct information on my coaching programs, please contact me at beth@purehealthysolutions.com

This form will take time and will greatly help me prepare for your participation in the program. Your time is valuable - as is mine. Completing the questions in this form in details will determine both whether this program is a good fit for you and if you're a good fit for the program. Your goals are very important to me and I want to know how I can best support you in reaching them!  

The process we'll be using in the group content and live sessions maximize the brain's potential to make and sustain healthy change.  I'll teach you techniques that you'll use between sessions and support you with gentle accountability that will get you across the finish line!  

Let's get started.

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Correo *
Are you a new or existing client?
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What prompted you to apply to the Program? *
In a few words, let me now why you're interested in group coaching and the Get Better series.
Describe your most important concern or challenge related to health and wellness. *
Let me know your most pressing health concern(s) so I can better plan our session together. It might be "lose weight", "learn more about healthy eating", or "improve my energy", or any other health or wellness related interest or concern.
Are you under the care of a doctor or other healthcare provider or taking any prescription medication? *
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What are the top results you'd like to achieve when working with me? *
Think big here! If you could have whatever wish for your health, what would it be? Try to be as specific as possible. For example, "I'd like to be able to have more willpower over what I eat" or "I want to wake up feeling energized and refreshed every morning". These are just examples so please, list whatever is meaningful to you here.
How would it feel for you to reach those goals? *
You could describe what you might feel when you achieve your health and wellness goals or what it would allow you to do or what it would mean to you to reach your goal.
Regarding your main concern, what have you tried in the past and how well did that work for you? *
Please share what, if any, other things you've tried to reach your health and wellness goals. It might be a particular diet or exercise program, for example.
Are you at the point where you really want to make positive changes and are ready to take action? *
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Contact info
Please fill in your contact information below. Complete the option that is the best way to get in touch.
Your name *
Phone number (include country code) or Whats App
Preferred contact method *
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Questions and comments (optional)
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