Client Application

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Client Application

Thank you for your interest in recovery coaching with Lindsey Nichol, LLC. Please complete this brief application as part of the intake process. If selected, you will be notified via email within 3 business days to schedule your free consultation. I appreciate your desire to become my client.

Email *

Record my email address with my response

Name, Email, Phone Number *

Age *

What days/times are you available to meet? (Please include your timezone) *

Briefly describe your biggest concerns/challenges impacting your health. Why are you seeking coaching? *

Have you tried to improve these areas before, and if so, what happened? *

Why is now the right time to make a change? *

Do you think friends and family will be supportive? *

Yes

Maybe

On a scale of 1-10, how important is it for you to make this change now? *

If you are selected and decide to work with me, how ready are you to invest in yourself and future? *

I have the necessary means to invest in my health and future

I have the ability to get the necessary means to invest in my health and future

I have no financial means to invest in my health and future

Are you looking to integrate Christian and faith-based principles into your recovery journey? *

Yes

Maybe

Please select which coach you are looking to support your recovery. *

Lindsey Nichol

Caitlin Young

Either

Required

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