Menopause, Rewritten

1:1 Coaching Experience Application

Thank you for your interest in working together.

Please take a few moments to complete the questions below. Your answers will help me understand more about where you are right now, what challenges you're facing, and what you'd like to achieve, so that we can make the most of our conversation.

Once you've submitted the form, I'll personally review your application and be in touch within 24 hours by email to arrange a complimentary discovery call. We can connect by phone or via Zoom, whichever feels most convenient for you.

Thank you for reaching out. I look forward to learning more about you and exploring how I can support you on your journey.

First Name *

Last Name

Phone *

Email *

Tell Me About You

1. What prompted you to apply for coaching right now? *

3. If nothing changed over the next 12 months, how would you feel? *

4. What would you most like to achieve through coaching? *

5. If we were having this conversation 8 weeks from now and you were delighted with your progress, what would have changed? *

7. Which statement feels most like you right now? *

I'm exhausted and running on empty

I've lost sight of who I am

I know I need to change but can't seem to move forward

I'm waiting for the right time, opportunity or permission

I'm ready for my next chapter

Your Health & Lifestyle

8. Are you currently exercising? *

Regularly

Occasionally

Not currently

11. Are you currently taking HRT or any medication relevant to menopause? *

12. What have you already tried to improve your health, wellbeing or menopause symptoms? *

13. Why do you think those approaches haven't delivered the results you were looking for? *

14. On a scale of 1-10, how committed are you to making meaningful changes over the next 8 weeks? *

15. What makes this a ___ and not a lower number? (copy) *

16. This coaching experience requires time, commitment and financial investment. Are you prepared to invest in yourself if we both feel this is the right fit? *

Yes

I'd like to discuss options

Final Question

17. Is there anything else you'd like me to know before we speak? *