The Wellness Client Application

Thank you for your interest in The Wellness — Private Coaching.

Please complete the application below. This program is a six-month, women-only, one-on-one coaching experience conducted online via Google Meet.

First Name

Age

Last Name

Phone

Location/ Time Zone

Occupation

What inspired you to apply for The Wellness — Private Coaching?

What areas of your life feel most out of alignment right now?

Have you worked with a coach, therapist, or mentor before? If so, please share.

What does support look like for you?

Are you able to commit to one-on-one coaching over Google Meet for six months?

Do you want to add the optional 10-Day Nourish Program (one-time $250 add-on)?

How did you hear about this program?

Anything else you’d like me to know as we begin?

Thank you! We received your application and someone will be in touch soon!