check

BalanceUP® Your Life & Business Breakthrough Session Application

Please complete this short from at least one day prior to your scheduled BalanceUP® Your Life & Business Breakthrough Session. Your responses are important in ensuring we make the most of our time together. This will likely take you less than 10 minutes.

If I have not already offered you a complimentary session, please use this form to apply. I have a limited number of complimentary sessions available each month. If I'm not able to offer a complimentary session this month, I may be able to the next. If not, I will provide guidance for other options via email.

Thanks, Simone

Click the button get started!

Start

Question 1 of 8

Your First and Last Name

Question 2 of 8

Your Email Address

Question 3 of 8

Best Phone Number to Reach You

Question 4 of 8

Your Website URL

Question 5 of 8

Why are you interested in BalanceUP Lifestyle Coaching? What are you hoping to accomplish?

Question 6 of 8

What is your #1 challenge in managing your business or lifestyle.

Question 7 of 8

Tell me a little about where you are at.

(Select all that apply)
A

I already have a business. I want to be more productive.

B

I have been contemplating whether entrepreneurship is right for me.

C

I want to focus on building my business in a way that better supports my well-being.

D

There are obstacles in my life holding me back from being my best and I'm ready to step forward and find a way to overcome these obstacles.

E

I would love to have a plan in place for managing my life when symptoms flare-up.

F

I have all the support I need in living my best life.

G

Sometimes I struggle to share my story with others.

Question 8 of 8

You're almost done! Tell me a little more.

(Select all that apply)
A

Sometimes the opinions and 'advice' of others wear on me.

B

I've been struggling to grow my business due to the impact of my health challenges.

C

All my triggers and symptoms are well-managed more than 90% of the time.

D

I could use help creating my own roadmap to overall wellness - a plan that works for me!

E

Sometimes I find all the information that is available online and from other resources confusing and overwhelming. I need a plan I can follow that is unique to me.

F

I would LOVE to live a BalanceUP Lifestyle, honoring my own needs so I can be my best for myself and for others.

Confirm and Submit