Mindset Coaching Application

Your body will only go as far as your mind allows. Fill out this form so I can understand your current mindset and what you're working toward.

Personal Information

First & Last Name *

Email Address *

Phone Number *

Age *

Gender *

Current City/State *

How would you describe your current mindset or daily routine? *

What habits are you trying to improve or build? *

What holds you back from being consistent? *

How do you handle stress, discipline, and motivation? *

What do you want to gain from mindset coaching? *

How do you define success for yourself? *

On a scale of 1–10, how accountable are you to your own goals right now? *

What do you believe is your biggest mental roadblock? *

What areas of life do you want to improve most? (Fitness, productivity, confidence, self-image, etc.) *

Anything else I should know

I'll review your application and get back to you within 24 hours with next steps.