THE BACK TO B.A.S.I.C.S. METHOD™ APPLICATION

Section 1: Basic Information

First Name

Last Name

Email *

Phone *

What is Your Instagram Handle?

Your Age

Are you currently:

Pregnant

Postpartum

Trying to Conceive

Other

If postpartum, how long postpartum are you?

Section 2: Your Current Struggle

What made you decide to apply today?

Which statement best describes how you feel right now?

I don't feel like myself anymore.

I've tried everything and still don't feel right.

I don't know who to trust anymore.

I'm afraid of making things worse.

I feel stuck and don't know where to start.

I just want my body to work again.

Other

Section 3: What Have You Already Tried?

After everything you've already tried, what do you feel is still missing? (For example: clarity, a plan, confidence, consistency, understanding what's actually causing the problem, accountability, lasting results, etc.)

Section 4: Where Do You Want to Be?

If we were having this conversation 6 months from now and you were thrilled with your progress, what would be different?

What would getting this problem solved allow you to do? (Examples: Pick up my kids without pain, Exercise confidently, Return to running, Feel like myself again, Stop worrying about my symptoms)

Section 5: Commitment

Why is now the right time for you to address this?

On a scale of 1-10, how committed are you to solving this problem?

Section 6: Investment

If we determine we're a good fit, are you prepared to invest in getting the support you need?

Yes, I want this to be my last investment

Possibly, if we can come up with a plan that fits my needs

No, I do not have any resources for coaching right now

Is there anything else you'd like me to know before our call?