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Peri Lean MethodTM Coaching Application Form

This is an application form for determining suitability for The Peri Lean Method (12 week 1:1 coaching program). The questions are designed to ensure we are perfectly suited as client and practitioner/coach so you can expect a superior results-driven service from our specialised skillset and experience working with evidence-informed nutrition and exercise science principles as it relates to the females in the menopause transition. It also ensures commitment and readiness to change on your behalf to ensure you are coachable to guarantee your successful outcome. Please response as honestly and with as much details as you can. 

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Question 1 of 19

Please provide your full name (first and surname, as well as preferred name). 

Question 2 of 19

Please provide your best contact email address.

Question 3 of 19

Please provide your best mobile contact number to ensure we notify you that your application has been successfully received and to arrange an application call. 

Question 4 of 19

Which city and country do you reside?

Question 5 of 19

What is your date of birth and current age?

Question 6 of 19

Please choose which stage of hormonal transition you are in. 

A

Pre-menopausal, normal menstrual cycle

B

Pre-menopausal, abnormal menstrual cycle

C

Perimenopausal (with or without symptoms or menstrual cycle irregularity)

D

Postmenopausal (>12 months since your last period or surgically induced menopause)

Question 7 of 19

Describe your health and fitness journey up until now including any diets you've tried (please let me know if you have a diagnosed eating disorder or history of one and your activity background).

Question 8 of 19

Why do you want to work with us?

Question 9 of 19

What is your main challenge when it comes to your health, managing the midlife transition, performance and body composition?

Question 10 of 19

Tell me about your menstrual cycle. Do you have >9 cycles per year? What is the average length of you cycle? Do you struggle with your period, if so, in what way? Are you on any form of contraceptive? If so, please name specific type and brand. 

Question 11 of 19

How has your nutrition behaviours impacted other aspects of your life? What is the impact of continuing your current behaviours going to mean for you in the future if you don't change?

Question 12 of 19

What are 3 characteristics you think you need to embody to improve your health, performance or body composition? (If it helps, you can base this off a mentor or someone you aspire to be like who is where you wish you were).

Question 13 of 19

If you started to act from a place of those characteristics right now, what do you think would be the outcome?

Question 14 of 19

We don't get to midlife without unravelling a few layers that have held you back, so if we get real and honest right now, what has prevented you from achieving the results you are after? The more specific you are the faster I can decide if you are a good fit for Peri Lean MethodTM coaching. 

Question 15 of 19

How ready and committed are you to start working on your goals/health right now? Choose a number from 1-5.

A

1 have no intention of changing my behaviours right now to achieve my goals or get results.

B

2

C

3

D

4

E

5 I am BUSTING to start actioning things NOW, let's do it!

Question 16 of 19

Do you have the resources and time to invest in your health, performance or body composition now?

A

Absolutely

B

I am not in the position right now to invest in myself fully

C

Other

Question 17 of 19

If accepted into The Peri Lean MethodTM Coaching, will you let your practitioner hold you accountable to your highest self and mirror your limiting behaviours or negative subconscious thinking patterns if necessary (including on our application call?)

A

Absolutely

B

I am not ready to face my limitations with an open mind just yet

C

Other

Question 18 of 19

Take a moment to collectively add up all the money to date you have spent on diets, supplements, vitamins/minerals, books, seminars, webinars, magazines, courses, challenges, memberships, equipment (e.g. ab rockers, lighter bike frame or specific running shoes etc). Is it in the vicinity of;

A

<$500

B

$500-$1000

C

$1000-$2000

D

$2000-$3000

E

$3000-$4000

F

$4000-$5000

G

So much I can't even fathom to add up

Question 19 of 19

Can you afford to invest  approximately $1000.00/month on your optimal mid-life health, mood, perimenopause symptoms, performance and body composition (knowing that The Peri Lean MethodTM is a 12 week coaching time frame and the last "diet" you will ever need to set you up for your next life chapter)?

A

Yes I am in a position to invest in my health and wellbeing with an expert in perimenopause nutrition

B

No I am not financially in a position to invest in myself and my optimal mid-life transition yet

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