Gender/Identity? ^*

Female

Male

Non-binary

Prefer not to say

Self describe

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What do you do for a living and how long have you been doing it? ^*

The more specific the better here

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Have you ever been diagnosed with any chronic illnesses? ^*

Ex: diabetes, asthma, heart disease, etc. If so, please list and/or describe

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Have you ever been diagnosed with any mental health conditions? ^*

Ex: Anxiety, depression, ADHD, bipolar disorder, etc. If so, please list and/or describe

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What have you previously tried to improve your well-being? ^*

I've tried to address my well-being on my own

I've seen a licensed healthcare professional

I've tried a health & wellness program

I've worked with a health coach/life coach

I've hired other help (ie personal trainer, nanny etc)

Other

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If you were deciding what Simie's next YouTube video is about, what would it be? ^*

/

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Are you ready and able to protect at least 60 - 90 minutes on Thursdays or Fridays for the next 6 months to work with Simie? ^*

Yes! I'm ready and able to protect at least 60-90 minutes on Fridays to work with Simie

No, I don't have enough time.

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Do you have a dream life and dream routine beyond what you're doing now? ^*

YES

I think so

Not really honestly... (that's ok!)

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Simie will be working very closely with you to ensure you have a real breakthrough in improving your well being so she can only take clients who are highly motivated and ready to for change. ^*

Please describe why you want to work with a coach right now and how you would ensure your success in achieving your well-being goals.

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Can't forget your name! ^*

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Email? ^*

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annnd location? ^*

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How did you hear about 1:1 coaching with Simie? ^*

YouTube

Email

Word of mouth

Other

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1:1 Coaching is a financial investment in your health and well being. Are you willing (and able) to invest $6,000 in getting the help necessary to experience the deepest transformation of your life? ^*

Payment plans are available*

Yes - I have the financial resources available to invest in my well being

Yes - I'm willing to get resourceful and/or have access to credit to invest in my well being because this is important to me

No - I don't have any additional finances to invest right now

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You're about to schedule a free 60 min application call where you and Simie will mutually decide if this program is the right fit for you. ^*

Out of respect for Simie's time and the applicants who are truly interested in getting help, 'no shows' will not be able to schedule again.

Click here to schedule your free application call.

Are you 100% certain that you will be on time to the appointment that you set in the link above?

Yes - I'm 100% ready to get started, I won't miss the call!

No - I'm not 100% sure about the times listed in the link

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Wahoo congrats on taking this step forward!

Here's the link where you scheduled your free call just in case.

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