Application form
Hi there!

I am so happy that you are here, and so proud of you for taking this first step!

I work with women who are ready to commit to make their goals a priority, want to transform their financial reality with ease and flow, get healthy so as to switch into high performance mode without dieting, and rewire their limiting beliefs to transform from the inside out FOR GOOD!

If this is you, then your next step is to complete this application form. This is crucial to help me better understand your current situation and also better understand what you need to RISE to the next level in your life.

After you complete the application, I will review your submission and contact you in the next 48 hours.

If I feel that my programs & services are exactly what you need to make quantum leaps in your health & business, I'll share with you your best next step.

If it is not the right fit, I will provide you with resources to help you uplevel where you currently are so that you can reapply to work with me in the future.

I am so excited to be the coach to guide you in your path to alignment & success.

Let's get started.

Dina Merhbi, Transformational Coach -

PS: mes services sont aussi disponibles en français. Si vous aimeriez que le formulaire soit en français, vous pouvez nous écrire :
Email *
Last Name, First Name *
Age *
Gender *
Which city do you live in? *
Please share how you came to find Dina. *
Tell me a bit about your business if you are looking for business coaching with me (who do you help, what do you offer)
What are you currently struggling with when it comes to your health &/or your business, what are the obstacles you're experiencing right now? *
How long have you been struggling with this? *
How does it affect your life (how and whom is affect by this other than yourself)? *
Have you tried to work on it in the past? What was the result? (what type of coaching did you invest in the past) *
Please rate your fulfillment regarding your health. *
Please rate your fulfillment regarding your wealth / finances. *
Please rate your fulfillment regarding your relationships (love, family, friends). *
Please rate your fulfillment regarding your business / career. *
Briefly describe a typical day in your life, including your schedule, daily responsibilities, eating patterns and other commitments. *
Can you relate to any of the following? *
When you envision your dream life what does it look like (imagine your ideal daily schedule, career/business, finances, your body & style, your health)? *
What’s one thing that you really want to make a reality in the next 6 months? Why is that important to you? *
On a scale of 1 to 10, how committed are you to taking your life to the next level by creating breakthroughs and overcoming the challenges you communicated above? *
Why do you want to work with Dina specifically, and what are you most excited about when it comes to working with her? *
Are you ready to invest to work on your goals alongside Dina? *
Any additional information you'd like Dina to know prior completing this form? *
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