Coaching Application

1:1 Coaching Application

If you are ready to dive into 1:1 Wellness & Mindset coaching, please complete the form below.

I personally review all applications and then will reach out to you to set up a free call. We will learn a little bit about each other, discuss your goals, and ultimately see if we’d be a good fit for each other!

Name(required)

Preferred Name (if different from given name)

Age (required)

Email(required)

Phone Number(required)

Do You Prefer Text/Call/Email?(required)

Have you ever worked with a coach before?(required)

What wellness areas you are interested in addressing? (Nutrition, Sleep, Stress, Movement, Mental/Emotional Wellness, Recovery and Regeneration) (required)

Tell me a little bit about yourself. Why are you considering 1:1 Wellness Coaching? Provide a brief description of what you would like to focus on through coaching. (required)

Do you currently have any wellness or life goals? If so, tell me a little bit about these goals. (required)

What barriers do you feel are getting in the way of achieving your goals or achieving your optimal wellness? (required)

What other professionals are you seeing (if any) to support your wellness journey? This could include a therapist/counselor, physical therapist, or additional wellness or fitness trainers. (required)

On a scale of 1 to 10 (10 being extremely ready and 1 being not ready at all) where do you think you would fall on your readiness and/or motivation to commit to your Ideal Wellness Vision?(required)

Nina Rose Peña