Mentor Membership Application (1:1 Coaching)

I'm looking forward to seeing if we'd be a good fit to work together 1:1! Please take a few minutes to answer these questions so I can get to know more about you and your goals.

Fill out this application and check your email after submission.

Click the button below to start.


Question 1 of 10

First & Last Name:

Question 2 of 10

Email address:

Question 3 of 10

What symptoms do you struggle with the most? List as many as you'd like:

Question 4 of 10

What day-to-day activities are challenging for you because of your MS symptoms?

For example: walking around in your home, walking outdoors, getting dressed, showering, standing long enough to cook a meal, etc. Get specific!

Question 5 of 10

What goals are you working towards (ie. improved strength, reduced fatigue, better balance, etc.)? What changes would you like to see?

Question 6 of 10

What is your current level of motivation to exercise?


I'm not motivated at all - please help!


Some days I'm motivated, others I'm not.


Mostly motivated.


Very motivated! I'm very accountable to my exercises on my own.

Question 7 of 10

How does it feel to know you no longer have to walk through this alone and will be fully support and guided in your journey ahead?

Question 8 of 10

Please provide your instagram account handle, if you use instagram.

Question 9 of 10

Please provide the url to your Facebook page (so I can reach out via DM's), if you use Facebook.
(For example:

Question 10 of 10

Where are you in your journey towards exercising to improve your strength, walking, fatigue, mobility, etc?


I have money to invest in myself and am ready to invest right away (if we're a good fit)


I want to invest in myself but don't have the resources/finances at present time


I'm not ready to make any investment in myself - I'm just trying to get as much free guidance as I can right now

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