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Daytime time-zone / Location *

Current occupation / business name

Your social/website

Request Details:

Select all that apply:

Business Consulting & Growth Strategy

Health + Wellness Coaching (Functional Health, Labs, Fitness)

Retreat Experiences

Online Workshops

If other please specify:

Briefly share why you are drawn to this/these services.

Preferred Start Date:

Preferred Contact Method:

What does success look like for you (in concrete terms: health goals, revenue number, body composition, number of clients, retreat experience, etc.) *

Clients Needs And Goals

What are your top 1-3 goals for working with me? *

If we were 6 months from now, and you looked back, what would need to be true for you to say: “That investment was absolutely worth it”? *

What have you tried so far (if applicable) and what were the results? *

What is your biggest challenge or obstacle right now in achieving those goals? *

For Health/Wellness Coaching:

Are there any health conditions or limitations I should know about?

Please briefly describe your current health status (any diagnoses, medications, major surgeries, known restrictions)

What are your current health habits: diet, exercise, sleep, stress?

What makes now the time to do this (why not later)?

For Business Consulting:

What is your business (type, industry, how long in operation)?

Who is your ideal client/market?

What is your main lead‐generation strategy currently?

What is your biggest business bottleneck right now (e.g., marketing, operations, team, product/offer development)?

For Retreat/Fitness Experience:

What is your availability: Spring/Summer/Fall/Winter 2026 or 2027

Have you attended a retreat or immersive wellness experience before? If yes, what did you love and what would you change?

Do you have any travel/physical/health constraints we should know about?

Our Fit and Expectations

Imagine you have unlimited time and money: what would your ideal business + health + lifestyle day look like? *

If you were a beverage (coffee, tea, smoothie, sparkling water, etc.), what would you be and why? *

What is your Enneagram or Human Design? *

On a scale of 1-10 how ready are you to show up every week/month and do the work required? If you’re less than 8, please tell me why. *

Why me? What about my background or style resonates with you? *

Are there any deal‐breakers or things you absolutely require in working together? *

What caught your attention about my work and what made you decide to apply today?

Agreement & Signature

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