WheelStrong

WheelStrong Coaching Application

(1:1 Session or 3-Month Transformation Program)

Read this carefully:

• This is not therapy or medical treatment
• This is holistic, neuroscience-informed, and energetically aligned coaching
• Results require effort, honesty, and consistency
• This is for people who are ready to take responsibility for their healing

 If you’re looking for a quick fix… this is not for you.

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Name *

First

Last

Email *

Number

Age

Location

Do You Currently Identify As:

• Disabled
• Able-Bodied
• Prefer Not To Say

If Disabled, briefly describe your condition…

What does a typical day look like for you right now?

What are your biggest current challenges?

What made you seek out coaching with me specifically?

What does a typical day look like for you right now?

What are the top 3 things you want to change or improve in your life?

If we were sitting here 3 months from now and your life had transformed… what would be different?

On a scale of 1–10… how committed are you to changing your life?

When things go wrong in your life, you tend to:

• Blame external circumstances
• Take full responsibility
• A mix of both

What patterns do you know are holding you back right now?

What have you already tried to improve your situation?

Why hasn’t it worked yet?

How do you typically deal with stress or emotional pain?

Do you believe your thoughts, emotions, and environment impact your physical health?

• Yes
• No
• Not Sure

Are you open to exploring: (Check All That Apply)

• Nervous system regulation
• Somatic healing
• Breathwork
• Meditation
• Energetic patterns
• Mindset rewiring
• Birth Chart specific protocols

On A Scale Of 1-10 How Would You Rate Your NUTRITION?

Selected Value: 0

On A Scale Of 1-10 How Would You Rate Your MOVEMENT/ACTIVITY?

Selected Value: 0

On A Scale Of 1-10 How Would You Rate Your SLEEP?

Selected Value: 0

On A Scale Of 1-10 How Would You Rate Your MENTAL HEALTH?

Selected Value: 0

Are you willing to make changes to your daily habits if guided?

• Yes
• No
• Depends

What are you expecting from me as your coach? *

What does accountability look like to you? *

Are you open to being challenged and called out when necessary? *

• Yes
• No

Which option are you applying for?

• 1:1 Soul Strategy
• Signature 3MO Coaching

How much time per week can you realistically dedicate to your growth?

Do you have any major life events or stressors coming up?

Coaching is an investment. Are you financially ready to invest in yourself right now?

• Yes
• No
• Need More Info

If What in

What would make this coaching experience “not work” for you?

Have you ever worked with a coach before?

Is there anything that might prevent you from fully showing up to this process?

Why do you think you haven’t changed your life yet?

Please Check Agreements Below To Proceed;

• I understand this is not medical advice
• I am willing to take responsibility for my growth
• I am ready to show up fully if accepted

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