Are you ready to WELLEVATE ™️ your wellness goals?
We are honored and excited to see if you are a good fit to work together on healing chronic health challenges naturally in our curriculum based private coaching program. Please complete the application form to help us learn about your specific needs and to determine if we are the best next step for you. In your responses, speak to the specifics as much as possible. We are only accepting a limited number of clients. This is your opportunity to leave an imprint and let us know why you'd be a great addition to the WELLEVATE ™️ community.
Are you currently living with a chronic health challenge?
Yes
No
If yes, how long have you been living with this health challenge?
0-1 year
1-5 years
5-10 years
10+ years
No health challenge but I have a pre-diagnosis
Is your chronic health challenge one or all of the below? (check all that apply)
High Blood Pressure/Hypertension
Overweight/Obesity
Kidney Disease
Diabetes
Does your chronic health challenge require prescription medication to manage?
Yes
No
If yes, how long have you been taking medication for this/these health challenge(s)?
What are your health & wellness goals over the next 12 months?
What is the biggest obstacle keeping you from hitting your health & wellness goal?
On a scale from 1-5 (5 being the highest), how important is it for you to reduce your reliance on medication & supplements?
1
2
3
4
5
What is your first name?
What is your last name?
What is the best email address to contact you?
What is your phone number
What is your FaceBook profile URL?
What is your Instagram handle?
Where are you located?
If you could heal your health challenge naturally, without reliance on medication, would you be interested?
Yes
No
If healing naturally and reducing your reliance on medication required you to embrace a whole foods diet within the next 30 days, could you handle it?
Yes
No
What kind of solution are you looking for right now?
I want a DIY solution (money is tight & I'd rather google search & do it myself)
I want a Done WITH Me solution (do the work with a coach to guide me to the solution)
If your application is approved, are you committed to showing up to the scheduled call on time?
Yes
No
I verify that the information that I have provided is true and correct to the best of my knowledge?
Yes
No
The mission of WellNeith® Coaching is to narrow the knowledge gap with education on natural healing practices to empower those dealing with chronic health challenges. Is this in alignment with your values?
Yes
No
May we inform you by text or Instagram direct message if you've been accepted?
Yes
No
Submit