Coaching Request Form | Highfrequencysecured

First name

Last name

Email

Phone

Preferred Contact Method

Email

Phone

Text

Current Goals & Challenges

Tell me more about your current lifestyle and habits. What’s working well, and what would you like to improve? Have you ever worked with a coach before? If so, what was your experience like?

Describe your current diet and any restrictions or preferences you may have. Are there specific health concerns you want me to consider in our coaching? Share your thoughts about your mindset and any challenges or patterns that may be holding you back.

What are your biggest goals and vision for your life? How would you describe your ideal future self?

Multi choice

Option 1

Option 2

Additionally, how do you prefer to receive support? Please check all that apply:

Gentle Encouragement

Direct & Tough Love

Practical Steps & Plans

Emotional Support & Conversations

When it comes to your transformation journey, how would you describe your commitment level?

Minimal Effort (Just Exploring)

Moderate (Willing to Do the Work but Need Guidance)

All In (Ready for Real Change & Accountability)

Agreement (Checkbox):

I understand that coaching is for guidance and empowerment, not medical treatment.

I commit to showing up fully for my growth.

Step Into Alignment. Start Your Coaching Journey.