Godiva Project Application

Welcome to
the godiva projectTM
Application

It's great to see you here!
I'm so honoured to have the opportunity to work with you
and be a part of your life-changing journey!

Let's get started to see
if we're a good fit!

Please tell me a little bit about yourself by filling out the following information. After all, we will be spending 12 weeks together and I want to make sure that this is the right program for you.

If you have any questions about this program or would like more information, please email me at: jenniferhale@health4lifewellness.ca

Let's get started...

(Don't worry! Your privacy is important to me so I will never share your information in any way. Everything will be kept confidential. Promise!)

* Indicates required field

Name *

First

Last

Birthday (DD/MM/YY) *

Email *

Where do you currently live? *

Contact Phone Number *

Occupation or Profession *

Why are you interested in this program? *

What are your 3 top goals? (i.e. lose 10 pounds, look younger, have more energy.) Please be SPECIFIC. *

Do you have any health concerns at this time: *

Please list any known food sensitivities or allergies: *

What are the biggest obstacles that are preventing you from reaching your goals? *

What do you hope to achieve by enrolling in this program? *

Are you at the point where nothing else seems to be working and you are finally 100% ready to take action and commit to yourself? *

Are you ready, willing, and able to be coachable, show up to coaching calls, make healthy lifestyle and diet changes that may be necessary for your success? *

How will you feel when you look and feel better than you have in a while? *

How will reaching/exceeding your goals affect your life? *

Submit

Thanks! See you soon!

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FREE STRATEGY SESSION

ACCREDITATION & AFFILIATES

TERMS & CONDITIONS

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DISCLAIMER: I am not a medical doctor, dietitian, or nutritionist. I do not hold a degree in medicine, dietetics, or nutrition. I make no claims to any specialized medical training, nor do I dispense medical advice or prescriptions. This content is not intended to diagnose or treat any diseases. It is intended to be provided for informational, educational, and self-empowerment purposes ONLY. Please consult with your doctor or wellness team if you have any questions regarding my whole foods program, and then make your own well-informed decisions based upon what is best for your unique genetics, culture, conditions, and stage of life.

Thanks! See you soon!

Join my mailing listFREE STRATEGY SESSIONACCREDITATION & AFFILIATESTERMS & CONDITIONS

FOLLOW ME ON SOCIAL MEDIA

Join my mailing list

FREE STRATEGY SESSION

ACCREDITATION & AFFILIATES

TERMS & CONDITIONS