1on1 Coach with Sandra - Application
Please fill in this form so I can see if we are a good fit, and I can find the best solution for you. THANK YOU :)
I'll be in touch as soon as I can!
Your First Name and Surname
Your Country of Residency & Time Zone
Skype Id or gmail address for google hangout
Check Your Current Symptoms
Food sensitivities (if yes, list them in one of the text boxes)
Blocked nose, Sinuses Infections, Chesty Cough or Hay fever
Skin allergies or itchy skin
Acne or Eczema
Bloating, Constipation or IBS
Fatigue, low energy
Mood swings, PMS, Depression, Anxiety
Thyroid or Adrenal problems
Thrush or Yeast infection
Urinary tract or bladder infections
None of the above, I feel fine
What is your desired health state? Tick all that apply...
Have more energy
Overcome cravings & master sugar free diet
Heal digestive system
Calm down inflammation in the body
Balance emotions and feel more cheerful
Kill Candida, SIBO and/or parasites
Boost immune system
Increase chances of having a healthy happy baby
How much money are you realistically prepared to invest in yourself and in this coaching program?
$30 - $50 (or equivalent in your currency...)
$50 - $100 (or equivalent in your currency...)
$100 - $500 (or equivalent in your currency...)
$500 - $1,000 (or equivalent in your currency...)
$1,000 - $3,000 (or equivalent in your currency...)
$3,000 - $7,000 (or equivalent in your currency...)
What would be the ideal time frame for me to support you on your journey to health?
just a call to bring me up to speed
a weekly call for a month for encouragement & accountability please
a weekly check in including food diary analysis for 3 months sounds good
I want to heal my digestive system from the ground up, and I am prepared to work with you for 6 months
I need a complete full body re-boot. Please help me adopt a healthy lifestyle, a positive attitude and heal my body top to toe, let's call it a year!
Check any of the following that apply to you:
I am already following a "healthy" diet.
I've been on some form of Candida diet for a while.
I am desperately ill and need someone to save me.
I am not fully healthy, but I am not desperate.
I am an action taker.
With a little help, I know I can get to the next level, and I will.
I blame others when I don't succeed.
Run me through what you've been eating these past three days (breakfast, lunch, dinner, snacks, drinks)
How often do you exercise and what kind of workout is it?
Also if you think you have Candida -- how long do you think you've had it? Have you done a test for it?
Can you tell me what the test was called and the name of the doctor?
What are your 3 month goals/ the big things coming up in your life, e.g. "want to lose 5kg, getting married next month, training for a marathon, exam coming up"?
What is your biggest obstacle and challenge?
What is the one thing that you'd do if you were fully healed? What can't you wait to do?
Why did you decide to fill out this application?
By filing in this form you agree you understand that I (Sandra Boehner) am not a doctor or nutritionist, and that before changing your diet or embarking on a new health regime you should see a doctor to assess your health, especially if you are feeling unwell. There's always a chance that the natural remedies and health strategies that helped me, might not agree with you. So be careful and listen to your body. That said, I will do my utmost best to help you, and I have yet to hear a complaint! Would love to support you.
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