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First Name *

Last Name *

Email *

How did you hear about Stacy J. Health Coaching? *

What are the health and wellness goals that matter most to you right now? Are there any habits or routines you’ve already established that support these goals? *

What challenges or obstacles do you find yourself facing most often when working to improve your health or build healthier habits? *

What steps or strategies have you tried in the past to improve your health, lose weight, and/or increase strength? *

Do you have fitness and/or strength training experience? *

Yes

No

Other...

Do you have any health concerns or injuries that I should be aware of, so I can provide the appropriate level of attention and support? *

Yes

No

Other...

Please Explain: *

Do you feel you would benefit from focusing on your mindset around food and exercise as a priority this time? *

Yes, absolutely.

I'm not sure. I don't know what that means.

I've done a lot of mindset work already and I'm ready to rock!

Are you open to the idea that meaningful change in mindset, nutrition, and movement takes time and that this program is designed for a longer-term commitment of at least six months? *

Yes, I'm excited about that. I'm not looking for a quick fix.

Maybe, I have an event that I want to feel my best for and I don't have that much time.

No, I need this weight off now, and I need a quick fix solution.

I offer mental fitness coaching, nutrition coaching, and personalized strength training programs. Please select all that you may be interested in. *

Mental Fitness - Positive Intelligence Program (6 weeks) Recognizing saboteurs, increasing positivity.

Nutrition Coaching - Building healthy habits, understanding macros, addressing and understanding emotional eating.

Strength Training - Personalized programs designes to help you build muscle and gain strength.

I utilize Zoom for weekly 30-40 minute coaching calls. Are you available for calls during business hours, 9-5 EST? *

Yes

No

It depends

Between 0-10, with 0 being "Not sure - resistant to change" and 10 being "100% ready and willing to change", how ready do you feel to start making small, positive changes that could help you think more kindly about yourself, feel more confident, move more freely, and improve your relationship with food and your body? *

I’m excited to work with those who are ready to invest in themselves. Are you in a position to financially commit to this journey and prioritize your well-being? (Program rates range from $299–$499/month, with variations based on the programming and level of support, such as strength training plans or weekly coaching calls.) *

Yes

No

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Stacy J. Health Coaching

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