Health Program Application

Screen coaching applicants across several short pages before you offer a discovery call. Candidates describe their goals, previous attempts, budget readiness and household support so you can judge fit quickly. Built for transformation coaches running a selective intake.

Use this template

Page 1

Full name

Nombre

Apellido

Email

Phone number

Link to your Facebook profile (or your full Facebook name)

Page 2

Occupation

Age and weight

Do you feel you need help?

Yes No Not sure

Page 3

What is your goal? Be specific - it does not have to be a physical goal.

What would matter most for you to call this work a success?

What have you tried before, why did it not work, and what is stopping you now?

Page 4

On a scale of 1 to 10, how determined are you to reach your goal?

Would you use a card, credit or financing if you decided it was the right step?

Does your partner support whatever you decide?

Yes No Not applicable

Page 5

What would you expect from me as your coach?

Places are limited - why do you think you would be a good fit for the programme?

Page 6

Programme investment

Are you prepared to invest financially to reach your goals?

If you are accepted, how soon would you like to start?

Page 7

I will take the call from a quiet, distraction-free place at the agreed time.

Yes No

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