The Running Health Coach: Application Form
Hi there, welcome and thank you for reaching out and inquiring about health coaching with me.

My name is Dr Bernadette Dancy, and I am The Running Health Coach. This means I help runners and endurance performers get a better balance between life stress and training stress. Why?

Working out and exercising is a great way to manage stress and mental health, BUT it means we can place disproportionate emphasis on training and forget about other areas of our health. The result of this?... We might be 'fitter' but are we 'healthy' in the true sense of the word?

If this resonates and you're someone who feels that running or training is so important to you for alleviating stress, managing mood and giving you a sense of purpose that you even train when ill, injured or simply life tired...then you're in the right place!

Health coaching with me will help you to establish what being healthy really means to YOU, give you a targeted approach to lifestyle changes, enhance your resilience to stress AND improve your running/training performance and so helping you to stay motivated and enjoy the activity that you love.

BUT before you sign up and commit to anything, please complete the following form in order to help me understand if you and I are likely to be a good coaching fit. After that I'll be in touch and we can get you booked in.

Coaching Options:

3 Month Intensive Programme (with 9 online skype coaching sessions; lifestyle coaching; running coaching) = £810

Ongoing Monthly Programme (with one online skype coaching session per month; lifestyle coaching, running coaching) £100/month



IMPORTANT:
All information provided here is confidential and stored on Google Cloud which is password protected. I will be the only person to have access to this information. That said, please feel free to share only as much as you feel comfortable to. If you would like this information to be deleted at anytime, please contact me to arrange this.

Once you have completed the form, I will be in touch to get you booked in.

Here's to a happier healthier you!

Bernie
Date:
MM
/
DD
/
YYYY
Name *
Your answer
Email Address *
Your answer
Age
Your answer
Occupation (and how many hours you work per week)
Your answer
How did you first find out about me and the work that I do?
What ONE word would describe how you feel about your OVERALL health right now?
Your answer
What ONE word would describe how you feel about your MENTAL/EMOTIONAL health right now?
Your answer
What ONE word would describe how you feel about your RUNNING/TRAINING right now?
Your answer
How would you describe your current ability to cope with stress?
Your answer
Have you ever experienced mental illness/chronic stress or burnout?
What physical and psychological symptoms does stress cause in you?
Your answer
What other health/fitness interventions (if any) have you tried in the past to better manage your mental health, and how successful was this?
Your answer
Why me? Why do you feel I'm the right health coach for you?
Your answer
How often do you currently run/train?
Your answer
Why is running/training important to you?
Your answer
What are your running/training goals?
Your answer
Do you follow a training programme?
Do you have a running coach/trainer?
Do you have any competitions/races planned in the next 6 months?
Your answer
On a scale of 1-10 how would you describe your MOOD this past WEEK?
Extremely low/poor
Excellent/Optimal
On a scale of 1-10 how would you describe your STRESS levels in the past MONTH?
Low
Extremely High
On a scale of 1-10 how would you describe your current sleep habits?
Poor (rarely getting desired amount of sleep)
Excellent/Optimal (always getting desired amount of sleep)
On a scale of 1-10 how would you describe your current nutrition?
Poor
Excellent
With no judgement whatsoever, can you share the area of your health that you are struggling with the most and what effect this has on you, your loved ones and/or your business/career.
Your answer
How would you like health coaching with me to improve your HEALTH?
Your answer
How would you like health coaching with me to improve your RUNNING/TRAINING?
Your answer
What ONE word would describe how you would *like* to feel about your health?
Your answer
In three months time, how would you like your health to be? How would you like to look/feel?
Your answer
What are the biggest barriers preventing you from improving your health and running performance right now?
Your answer
Why is now the right time to engage in health coaching?
Your answer
On a scale of 0 to 10 HOW READY ARE YOU to improve your resilience to stress, enhance your running/training performance and have better health overall?
Not ready at all
100% Ready for Change
I coach all my clients over video call/Skype/Facetime/Whats APP. In order to make sure I have a time slot free for you please outline your availability below. Sessions typically last between 40-60 minutes.
Your answer
THANK YOU!
I aim to get back to all applications within 24 hours of receipt. Please do check your spam/trash folders if you don't see my reply and if you still don't find it do give me a nudge by emailing me - bernadettedancyhealthcoach.co.uk
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy