PCOS Holistic Coaching Application
Thank you for your interest in 1:1 transformational coaching! Once the form is submitted and if approved to move forward, you will receive details to set up the FREE 30-minute consultation. This is to learn more about your lifestyle and your health goals to determine if we are a good fit for one another. I look forward to speaking with you soon! -Dr. Ami
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Email *
Name
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Phone number
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Date of Birth
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Where are you located and what is your time zone?
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How did you hear about the 1:1 coaching program with PCOS Holistic Coach?
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What are your health goals?
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What symptoms do you currently struggle with the most?
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What have you tried to manage the symptoms?
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Since trying to resolve this issue, how much do you estimate the financial cost has been (including doctors visits, dietitians, personal trainers, supplements, medications, other treatment options, programs etc)
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Please provide a brief description of your lifestyle including the following topics-

diet (ie vegan, vegetarian, gluten free or dairy free), exercise, sleep, stress, current mindset/concerns about your condition

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Who is part of your support system?

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How committed are you to taking control of your health and achieving your goal? On a scale of 1-5, with 1 being "not ready yet" and 5 being "ready to get started like yesterday"

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not yet ready
ready

1-on-1 transformational coaching packages range from ~$999 to $2399 USD for 1 to 6 months or $200 USD/1-Hr consultation. Are you ready to financially commit to this investment in your health and well-being.  *(discounts and payment plans are available)* If yes, which package are you interested in?

(The 1-hour consultation is a one time meeting where I give you feedback and advice on lifestyle changes to implement as well as answer any questions you have about your PCOS, medications and supplements. With the multi-week program, we strategically work on how to implement the lifestyle changes. I help you overcome any challenges you have along the way, while keeping you accountable and encouraging you regularly.)

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Once your application is reviewed and approved, you will be contacted via email to have a complimentary 30 minute consultation, if you selected the 4 or 12 session packages, where we will go further into your goals and how I can best support you in meeting them. The 1 hour consultation does NOT come with a free 30 min call, you will receive an email with details on how to schedule and proceed with consultation.

Would you like to submit this application?

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I would like to be added to the exclusive PCOS Holistic Community mailing list!
You can expect up to 4 emails per month on various PCOS topics and be the first to know about upcoming events!
We do not send spam.

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