6 Weeks to Wellness Group Challenge Application
Fill this form out as best you can so your coach can get to know you and your goals better!
Phone number (I will call you for a discovery chat - If you prefer a text or email to nail down a time, please specify here).
How old is/are your "baby/babies"?
Did you have a vaginal birth, C-section or did someone else carry the baby for you? Explain any current birth related issues (ie. scars still healing, numbness, etc.)
Are you currently breastfeeding?
Please check which of the following reasons best describes why you signed up for this program (check all that apply):
I need more motivation to exercise, eat healthy and take care of myself
I need more accountability to exercise, eat healthy and take care of myself
I need more information and coaching for fitness and nutrition practices
I am having trouble finding a fitness solution that is sustainable
I am burnt out and feel like I can’t find any time to take care of myself
I need more support around me as I prioritize my health
I need help balancing all of my responsibilities while prioritizing my health and wellness
In which of the following situations do you find it hardest to stick to your health and wellness goals or triggers unhealthy habits? (check all that apply)
Stress at work or at home
Feeling emotional (happy, sad, anxious, frustrated...)
Eating with the kids
Sweets that are readily available
Describe your goals (ie. weight-loss, pain management, sports cross training, establishing a healthy routine, etc.):If weight-loss, please let me know the number of pounds you think you'd like to lose:
Do you have any “problem areas” in terms of chronic pain or joints that get inflamed or cause pain? Describe any areas that you already know need strengthening or areas you would like to focus on for strength training?
Do you have any current fitness routines? (ie. Classes you take regularly, walks, gym member- ship, etc.)
In your words, what are your biggest challenges when trying to adopt healthier eating habits or stick to a diet?
Which best describes your weekdays?
Stay at home mom
Full time work from home mom
Part time work from home mom
Part time job outside of the home
Full time job outside of the home
Why do you feel like this group challenge is for you?
Is there anything else you'd like to mention or discuss?
Send me a copy of my responses.
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