Coaching Application
Are you ready to change the way you eat to support your health and transform the way you feel, but feeling overwhelmed about all the changes you need to make? Are you concerned you won't know what to eat, how to make the new food a part of your life, or won't stick with it long enough to get better? I'd like to help you make the changes you need so they feel easy and will support your healthy life lived with energy and vitality!

This questionnaire will help to determine where we should focus our discussion to make the most of our time and so you can leave with the greatest benefit from it. I'll review your application and will be in touch within 2 business days. Thanks so much!
Sign in to Google to save your progress. Learn more
1. Full name: *
2. Email address: *
3. Phone (North America). For clients outside North America, we will meet via Zoom. *
4. Your age: *
5. How did you learn about Ricki? *
6. Please describe the 3 MAIN obstacles or worries you have around sticking to your healthy diet. *
7. What have you tried so far to overcome your challenges? Please list any programs you've taken, kinds of practitioners you've worked with. *
8. On a scale of 1-10 (1 being "not at all" and 10 being "I'm ALL in!"), how willing are you to make changes to your diet in order to heal? *
9. On a scale of 1-10 (1 being "unimportant" and 10 being "emergency"), how important is it that you get your diet and lifestyle under control right away? *
10. Why would you like to work with Ricki as opposed to someone else? *
11. The time, personal attention and finances required for better health and lifestyle can be substantial. Have you already consulted with anyone else who has a say in your decision, and are you prepared to invest the $2500 for coaching? *
12. Is there anything else you'd like to add, or that you think is important for me to know?
Thank you! I'll be in touch soon about a free call where we can further discuss the possibilities of working together.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy