One-on-One Coaching Application | Nina Baez Coaching

First Name

Last Name

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Are you struggling with any medical conditions?

How did you hear about this program?

What struggles are you currently experiencing in your health journey?

Emotional/stress eating

Viewing foods as “good & bad”

Self sabotage related to weight loss

Obsession or fear of the scale

Exercising too much

Always trying new diets or exercise programs

Feeling the need to go to extremes for weight loss

What goals are you hoping to achieve in the next 3 to 6 months?

In what ways have you invested in your health previously?

Why do you feel the past methods you have tried haven’t worked?

What qualities are you looking for in a coach?

For what reasons would you NOT invest in a coach right now?

Any other information about yourself that you would like to provide?