Premium 60-Day Coaching Program – Application Form

Thank you for your interest in Miwa’s Premium Coaching Program.
Please complete this short questionnaire so we can understand your current situation and goals.
After submission, you’ll receive a link to book your free 15-minute info session with Miwa.  

Please read before applying

I only welcome clients I truly believe I can support—because I want every client to experience meaningful results. I dedicate 100% of my time and expertise to each person I work with.

To do that, I need to understand you deeply. Please answer as fully and specifically as you can. If your responses are too brief for me to understand your situation, I may have to decline the info session. I hope you understand this.

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Name *
Email
Age *
Family Members / Household 
Country *
1. Please describe your typical daily schedule
(Example:
6:00 Wake up → Breakfast prep → Start work
12:00 Lunch → Afternoon work
17:00 Pick up kids → Dinner prep
20:00 Dinner with family → Clean up
23:00 Sleep)
 *

2.How often do you currently cook? 
Multiple choice is ok

 *
Required

3. How do you feel about cooking? (check all that apply)  

 *
Required

4. What do you often eat or rely on these days?
(Example: takeout, frozen meals, bread + snacks, etc.)

 *

5. What physical or emotional issues do you feel are connected to your eating habits?
(Examples: fatigue, digestive issues, skin problems, low mood, etc.)  

 *

6. How does this affect your daily life or your family?  

 *

7. What is your goal for your eating habits after 60 days both emotionally and physically?

 *

8. Are you willing to follow the weekly coaching actions during these 60 days (such as making a meal plan or trying 1–3 new dishes)?  

 *
Required
9. If your motivation drops, what kind of support would help you continue? *
 10. When you think about past times you tried to change your eating habits, what do you feel got in your way?   *
11. What is the one most important thing you want to achieve through this program?   *
12. On a scale from 1 to 10, how ready are you to commit to your own health journey right now? *
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