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Wellness Within Consultation Form

This is the first step toward creating the healthiest, happiest version of you. Please complete this short form so I can learn more about your goals and see if Wellness Within is the right fit for you.

Are you ready to finally create results that last?

I’m so excited to help you inside of my Wellness Within 1-on-1 Coaching Program.

I’d love to learn more about you and your goals! Spots for 1:1 coaching are limited, so take a minute to fill out this quick form. Once you do, I’ll reach out personally via email with the next steps.

Full Name *

Email *

Phone *

Age *

What are your top 3 health or fitness goals right now?

What do you feel has been holding you back from reaching these goals?

What have you tried to reach your goals in the past? What worked and what didn’t?

Why is now the best time to make a change?

On a scale of 1–10, how ready are you to commit to making a change?

1-2 (not so ready)

3-5 (thinking about it)

6-8 (almost ready to commit)

9-10 (READY, let's do it!)

Are you open to being coached, held accountable, and guided through challenges when they come up?

Yes

No

I'm not sure

What’s your biggest struggle when it comes to staying consistent?

If we’re a good fit, are you ready to invest in yourself (time, energy, and financially) to reach your goals?

Yes, I’m ready now

I’d need more info but I’m open

No, I'm not ready

Is there anything else you’d like me to know before we connect?

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Let’s build lasting results from the inside out and a body, mindset, and lifestyle you’re proud of.

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Email

luisana@lcwellnesswithin.com

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