FREE 15-minute Discovery Call - Chronic Wellness Collective

Duration: 15 minutes
Name: *
Email: *
Cell Phone: *

Tell us about your interest in coaching

What are your three biggest health challenges right now?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

What would you like support with over the next 3 to 6 months?{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Is there a specific coach you are interested in working with?Yes, there was someone in particular I'd like to work with.No, it doesn't matter as long as it fits my budget.Maybe, depending on how much it costs.{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Yes, there was someone in particular I'd like to work with.\nNo, it doesn't matter as long as it fits my budget.\nMaybe, depending on how much it costs."}

Which coach(es) are you interested in working with?{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Katherine Housh, BSN, RN\nMargo Kalayjian, MA\nDanielle Aslaksen\nAnyone is fine with me"}

What is your MONTHLY budget for coaching?{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"More than $300\n$200-299\n$150-199\n$100-149\n$50-99\n$25-49\nLess than $25"}