12-Week Glow Up Experience
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Fill out the questionnaire below to begin then pick your time on calendar:
First Name
Last Name
Email
Do you currently have a business or consider yourself an entrepreneur?
Yes
No
If you are an entrepreneur, how long have you been in business?
0-3 years
4-7 years
8+ years
Have you ever worked with a life coach before?
Yes
No
What are you currently struggling with? (select all that apply)
Confidence
Weight/appearance
Confused on purpose
Being happy
Showing up in business
Self-limiting beliefs or negative self-talk
Constant approval seeking
Accountability and support
Self-sabotage
Not knowing who you are or how to be you
Have you been diagnosed with clinical depression, ADHD or any other condition?
Yes
No
Are you currently seeing a counselor, therapist, psychologist or other mental health professional?
Yes
No
As a life coach, do you understand that I cannot diagnose, treat or provide medical advice?
Yes
No
Have you ever been diagnosed with an eating disorder?
Not diagnosed but believe I may have one
Yes, but I am currently working with another professional
No
Yes but it's resolved
Would you say you are:
Too busy to cook and will need meal provider
Do not mind and will cook daily
Name your #1 goal from life coaching:
I'm ready to crush my goals!
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