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EclecticWellness 6-Week Pilot Program 
Welcome! I’m so excited you’re interested in joining my pilot program. This is a special, limited-time opportunity to work with me at a deeply discounted rate of $150 for 6 weeks (regular value $420+).
This program is designed for women — especially moms — who are ready to:

✨ Build healthier habits

✨ Improve fitness & nutrition

✨ Learn simple, sustainable self-care

As part of this pilot, you’ll receive:

✅ Weekly workouts & modifications

✅ Budget-friendly meal guidance

✅ Skincare/self-care tips

✅ Coaching & accountability

In exchange for the discounted rate, I ask for your full participation and honest feedback/testimonial at the end of the 6 weeks.

Please complete this form carefully. Spots are limited and will be confirmed on a first-come, first-served basis.


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Email *
Full Name *
Email Address  *
Phone number  *
Age *
Are you a mom/caregiver? *
What is your biggest wellness goal right now? *
What is your biggest challenge with staying consistent? *
Why do you want to join this 6-week pilot program? *
Are you comfortable providing honest feedback/testimonial at the end of the program? *
If selected, are you able to commit to the discounted pilot rate? *
Confirm that you understand this is a limited-time pilot program at a reduced cost and spots are limited. *
Required
A copy of your responses will be emailed to the address you provided.
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