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Apply to Work with Gabriella:
Client Application Form
Please complete the entire form and click submit at the bottom.
Average completion time is 10 minutes.
First Name
Last Name
Email
Phone Number
Address
Address Line 2
City
State
Zip Code
Age
Gender
Female
Male
Transgender Female
Transgender Man
Non-Binary
I Dont Identify with Any Gender
Education
Less than high school
High school diploma or GED
Some college credit, but no degree
Associate degree
Bachelor's degree
Master's degree
Professional degree
Doctorate
Trade/technical/vocational training
How did you hear about Welltality Coaching and/or Coach Gabriella Testa?
What made you choose to apply to Welltality Coaching versus another coaching company for services?
Which coaching container program are you interested in applying to?
3-Month Discovery Program: reviveHER
6-Month Signature Program: elevateHER
12-Month Extensive Program: renewHER
Why are you interested in being coached?
What do you hope to accomplish by working with me?
Have you used one-to-one coaching services before?
Yes
No
If you have used coaching services before, what was your overall experience?
Very satisfied
Satisfied
Somewhat satisfied
Somewhat dissatisfied
Very unsatisfied
I have never used coaching services
What contributed to your past satisfaction or dissatisfaction with coaching services? If you have never used coaching services before, comment N/A.
What three main challenges are you dealing with today?
What's causing you stress? Keeping you up at night?
In regard to reaching your goals, what have you tried in the past? What is holding you back? What is getting in the way?
What's your top unmet desires?
Rate your health on a scale from 1 - 10, with 1 representing extremely poor, and 10 representing thriving and optimal.
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Rate your current health, wellness & longevity self-care prioritization on a scale of 1 - 10 ( 1 representing extremely limited time or focus on self-prioritization, and 10 representing optimal time and focus).
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Rate where you would ideally like your future health, wellness & longevity self-care prioritization to be on a scale of 1 - 10 ( 1 representing extremely limited prioritization, and 10 representing fully and optimally committed).
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What area is most important to you to work on in a coaching program, and to improve and reach your goals?
Health
Wellness
Longevity
Purpose
High Achiever stress & burnout
Two of these options
Three of these options
Other
All of the above
Please provide more information around your interest in working on these areas.
How would you feel if you reached your goals? What would your future look like? How do you see your future self?
What's keeping you from obtaining or becoming what you want?
Envision yourself going through this coaching program with me - See yourself 6-months to a year from now? Who are you in this vision? How do you look? How do you feel? Who do you hope to be?
On a scale from 1 - 10, how motivated are you to get started in my coaching program? (with 1 representing not ready at all, and 10 representing extremely ready).
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Please comment and explain your rationale for your score in the last question.
Is there anything else that you think is important for me to know about you?
Are you committed to solving your problems and accomplishing your goals?
Yes
No
Undecided
Are you ready to elevate and become your best future self?
Yes
No
Undecided
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