The Balanced Company 1:1 Coaching Application
*Please read before beginning your application*

This application is designed to help me determine if you and The Balanced are a good match for 1:1 coaching. Only fill this form out if you a READY to commit to 12 weeks of self-discovery and transforming your life.

We are looking for women who are action-takers and are ready to invest in themselves. If this sounds like you, we would LOVE to hear from you!

Email address *
First Name? *
Your answer
Last Name? *
Your answer
Email Address? *
Your answer
Instagram Username? *
Your answer
Phone Number? *
Your answer
Age? *
Your answer
Location? *
Your answer
What is your main health, fitness, or mindset goal RIGHT NOW? What is holding you back from achieving it? *
Your answer
What is your secondary health, fitness, or mindset goal RIGHT NOW? What is holding you back from achieving it? *
Your answer
Why are these goals important to you? What motivates you to achieve them? *
Your answer
If you achieved these goals, how would would your life be different? *
Your answer
What does your current nutrition and workout regimen look like? Are you consistent with it? What results have you seen? What results haven't you seen? *
Your answer
Which services are you interested in?
My coaching packages are a 12 week commitment. If we both decide that it is an absolute YES! to work together, are you prepared to invest both monetarily and personally? *
Do you have any history of eating disorders, self-harm, or any related conditions OR any physical condition that impacts your diet and exercise program? If YES, please elaborate. Please note note that I do not accept clients with current eating disorders and will refer you to someone who specializes in that area. If you are RECOVERED from a disorder, I require a letter from a counselor/doctor/therapist stating you are cleared for fitness and/or nutrition and/or mindset coaching.
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