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!
Email address *
Name: *
Your answer
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).
Your answer
How old is/are your "baby/babies"? *
Your answer
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.) *
Your answer
Are you currently breastfeeding?
Please check which of the following reasons best describes why you signed up for this program (check all that apply):
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)
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:
Your answer
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?
Your answer
Do you have any current fitness routines? (ie. Classes you take regularly, walks, gym member- ship, etc.)
Your answer
In your words, what are your biggest challenges when trying to adopt healthier eating habits or stick to a diet?
Your answer
Which best describes your weekdays? *
Why do you feel like this group challenge is for you?
Your answer
Is there anything else you'd like to mention or discuss?
Your answer
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