Application for coaching

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Application for Initial Consult Call

Rachael Lynne, Health and Wellness coaching

Thank you for your interest in working with me!

Please fill out the following form in as much detail as possible to prepare for our initial consult. I will never share any of the private information that you disclose here, whether we end up working together or not.

After I receive your application I will be in touch within 3 business days at the latest to provide date and time options to sign up for an initial consult where we can evaluate if my services are a good fit for your goals.

    Email:

    Name:

    Phone Number:

    Date of Birth:

    Gender:

    How did you hear about my services?

    Are you a First Responder? If so, in what line of work and what is your role?

    How many years have you been working as a first responder?

    Do you feel your health has since you began your career

    What do you feel are the primary job related challenges to your health at this time?

    What are your top 3 Health concerns at this time?

    Are you currently following a diet? If so can you expand on what that looks like?

    Have you ever been diagnosed with or have history of an eating disorder?

    Are you taking any prescription medications and or supplements? Please list below

    Are you currently under a practitioners care for a specific health issue? If so please describe

    Are you following a workout plan? If so please describe

    Do you have any injuries or physical limitations

    Do you have any previous experience with Resistance training

    Do you have access to a gym?

    What are your top 5 Goals right now?

    There are a lot of health coaches out there, why are you interested in working with me?

    On a scale of 1-10 how committed are you about making changes to your health?

    In the event we end up working together, what does a successful outcome look like to you? (Have fun with this, and think big! What does your life look like, how do you feel what changes have you made?)

    Is there anything else you would like me to know before our consultation? If yes please describe and give as much detail as you would like.