1-on-1 coaching application

Starting can be overwhelming and scary, but let me assure you, we will work as a team and conquer TOGETHER.

In order to get started on the right path, I ask that you fill out the form below. Your time is precious, as well as mine. When filling out the questionnaire, please be honest and thorough with your responses, to ensure that I can get to know you, your history, your goals, and how I can help you along your journey.

First Name

Email Address

Last Name

Date of Birth

Phone

Preferred way of contact

Phone

Text

Weight

More information about your goal(s). OPTIONAL

What are you currently doing for your health and fitness?

Have you tried anything in the past (or recently) to change your habits, your health, your eating, and/or your body? If so, what?

What is your biggest struggle(s)?

What is your ultimate long-term goal?

If you answered less than 9 (<9), why didn't you rate that higher?

Why are you committed to working with culture and health co. (Kindra)?

We fully believe that if everything is not a "heck yes" it's a no. If you decide you are a good fit for what we offer, do you have the financial resources available to commit to this coaching program starting after our call? Note: please do not schedule a call if you are not able to start immediately - we do offer variable payment options.

Heck yes!

I do not have the financial resources at this time.

After you hit submit, be on the watch for a message from Kindra to schedule a call. If you want to provide additional information, please feel free to do so below.

Thank you for submitting! Be on the watch for a message from Kindra to schedule a call.