Name *

First Name

Last Name

Are you willing to participate in weekly check-ins and actively communicate through the coaching app? *

Yes

No

Are you willing to be honest with yourself and me about what’s working and what’s not, even when it feels hard? *

Yes

No

Are you able to commit to the initial 12-week coaching program? *

Yes

No

Are you able to commit to the initial 12-week coaching program? *

Yes

No

Does the investment of $249 per month or $747 upfront for coaching fit within your budget at this time? *

Yes

No

I understand that this coaching program is not a substitute for medical advice or treatment. *

Yes