WholeHardy Health, LLC

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* 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.

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* 2. Today's Date

Date

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* 3. Contact Information:

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* 4. Describe the state of your mental & physical wellness as it is right now:

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* 5. How do you currently acknowledge the connection that your inside world (your MIND) has with your outside world (your BODY)?

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* 6. What are the 3 biggest obstacles stopping you from taking your mind & body to your ideal picture of health?

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* 7. What are your current habits in these 3 areas:
1) Food:
2) Fitness:
3) Focus (Mind Work):

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* 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:

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* 9. What does Wellness Success look like to you? 

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* 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
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i We adjusted the number you entered based on the slider’s scale.

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