Total Wellness Private Coaching Application WholeHardy Health, LLC Question Title * 1. Yes, Katie. I want to partner with you and gain full access to your coaching, mentoring, network, guidance and expertise as a Member of Total Wellness Private Coaching. I understand that you will use this application to select the ideal group of like-minded mind & body health seekers who are committed to physical & mental well-being, and that you will let me know within 3 business days whether I’ve been selected for the group. Heck Yes, I'm Ready! I think I'm ready ... Question Title * 2. Today's Date Date / Time Date Question Title * 3. Contact Information: Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Mobile Number Question Title * 4. Describe the state of your mental & physical wellness as it is right now: Question Title * 5. How do you currently acknowledge the connection that your inside world (your MIND) has with your outside world (your BODY)? Question Title * 6. What are the 3 biggest obstacles stopping you from taking your mind & body to your ideal picture of health? Question Title * 7. What are your current habits in these 3 areas:1) Food:2) Fitness:3) Focus (Mind Work): Question Title * 8. What methods have you tried previously that did and did not work for you?1) Did work for me:2) Did not work for me: Question Title * 9. What does Wellness Success look like to you? Question Title * 10. On a scale of 1 to 10, how EXCITED are you to start creating a healthier mind so you can build your healthiest body THIS MONTH? 1 10 Clear i We adjusted the number you entered based on the slider’s scale. Done