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1:1 Holistic Health Coaching Application

Let’s See if This Journey is Right for You

Thank you for your interest in working together! My 1:1 coaching program is designed to support women ready to take control of their health, uncover root causes, and create lasting transformation. Because of the time and care I give each client, I only accept a small number of women at a time.

Please complete this application honestly and thoroughly so I can determine whether this is the right fit for your goals.

Email *

Phone *

First Name

Age

Location

Preferred Method of Communication

About You & Your Health Goals

What inspired you to explore 1:1 coaching at this time?

What are the biggest challenges or frustrations you've been facing in your health journey?

What are your top 3 health goals right now?

Have you tried any programs, diets, or therapies in the past? What worked? What didn’t?

Do you have any diagnosed medical conditions or current health concerns I should be aware of? (You can be as general or detailed as you feel comfortable.)

Are you currently working with any other health professionals? (MD, nutritionist, therapist, etc.)

Readiness & Commitment

On a scale of 1–10, how ready do you feel to make changes to your health habits right now?

What kind of support and accountability are you looking for from a coach?

This coaching program is a partnership. Are you willing to take full ownership of your habits, decisions, and progress?

Yes

Unsure

Coaching requires time, energy, and a financial investment in your health. Are you ready to invest in yourself if accepted into the program?

Yes, I’m ready to invest

I’d need more information

Not at this time

Final Thoughts

Is there anything else you'd like me to know about you, your lifestyle, or your goals?

How did you hear about this coaching program?

Social media

Referral

Website

Other

What’s Next:

Once your application is reviewed, I’ll personally reach out within 48–72 hours. If it feels like a great fit, I’ll invite you to schedule a free 20-minute clarity call so we can connect and make sure this is the right next step for you.

1:1 Holistic Health Coaching Application

Let’s See if This Journey is Right for You

Led by a Registered Nurse. Backed by real solutions.

Built for your success.

Let Tina help you discover the healing power already within you.