Coaching Application Form
Hey beautiful ! I'm so happy you're here. 

I would love to know more about YOU!

This application is for 1:1 nutrition coaching. 

Due the tailored and individual level of support you receive during this program, there is an application process. It MUST be a perfect fit for both YOU and for me.

The investment for 1:1 coaching begins at a few hundred dollars per month and is a 3-month minimum commitment. After 3 months you can go month-to-month! Most of my clients work with me 6-12 months. 

You Can Now Use HSA/FSA to Pay for Coaching! I’ve partnered with Truemed, and you may now be eligible to use pre-tax dollars in 3 simple steps. Ready to start saving? Click the link below to get started: https://app.truemed.com/qualify/tm_qual_vu9v9dgixy 

 After I review your application, I'll reach out within 24 hours via email!

I can't wait to meet you, let's get fit and healthy together!!!

I am accepting new 1:1 Clients for September 2024!
 
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What is your first name? *
What is your last name? *
What is your best Email *
How old are you? *
What is your phone number? *
What is your Instagram Handle? *
Are you interested in habit based coaching or macros?
Which best describes where you are right now in your health + wellness? Check all that apply. *
Required
Now, tell me your GOALS! Where do you want to be in 3-6 months from now? What transformation do you want to see in your life? Be specific! I've got you! *
What are 3 of your biggest challenges when it comes to your health + well-being? *
Have you tracked macros before? *
Why is now the perfect time to hire me as your coach and invest in yourself? *
What has not worked really well for you in the past - and why do you think that was? *

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 What past diets have you done? When was your last diet?


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What hesitations or concerns do you have about 1:1 coaching? *
Ready to take responsibility for your results? Are you willing and ready to show up fully, be coachable, stretch your comfort zone and be an ACTIVE client/? Are you ready to invest in yourself and your overall wellbeing at this level? *
In order to provide the best experience and results, I require a 3 month commitment. Are you able to commit to at least 3 months to begin? *
What is your ideal start date?
How did you find Danielle? *
Is there anything else you want to add? *
By submitting this form, you acknowledge that Danielle Havens is a nutrition coach. She is not a registered dietician or physician. She is ready to help you reach your health and fitness goals, but this program is not intended to be taken as medical advice. It is recommended that you consult with your medical provider for approval and medical clearance before starting this program. By submitting this form, you are accepting full responsibility for your actions.*

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