Contact – The Uncommon Balance

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For general inquiries and questions, please feel free to email, call, or send me a message by filling out the contact form below.

Training Interest Form

Name

Phone

Date of Birth

Your Fitness Focus

Strength Gain Weight Management Toning/Reshaping General Health

1. Tell me more why you're here. What are your current fitness goals?

2. What is preventing you from reaching these goals?

3. On a scale of 1-5 how important are these goals? (5 being the most important)

4. Have you had experience in the fitness world?

5. If you answered yes to 4, what did you do?

6. Tell me about your current fitness habits and movement preferences.

7. Do you have any major health issues that you're aware of?

8. Do you experience pain or discomfort? If so, where and how often?

9. How many sessions per week are you interest in?

10. Please tell me anything else I should know.

Dear Pain Submission

Please begin your entry with, “ Dear Pain “. Write as if you are informing someone who just got diagnosed themselves, or who has been experiencing the same kind of pain you have also been living with. Lending your heart, experience and depth of knowledge could potentially help someone in a similar situation.

Please be as REAL as you can when sharing YOUR story… We really want to give truth to what we are all experiencing. The goal is to connect / bring awareness / comfort to one another.

Questions to think about for your entry

What are you currently battling with? Or what have you battled with in the past?
What does/did your pain FEEL like?
What kind of western/eastern medicine have you tried? Did it work?
What have your experiences with doctors been like?
How do you stay positive through the rough days?
What tips and tricks do you have that you think would benefit someone else? (Emotional or physical)
What is one thing you can’t do because of your pain?
What is one thing you are working towards achieving?
What can you do despite the pain?
How can you inspire someone to find a balance with their pain?

Name - Optional

Social Media - Optional

Diagnosis, or symptoms if undiagnosed.

If you're comfortable please upload 1 or 2 photos of yourself. Alternately you can upload images of your treatment or something you feel connected to.

Dear Pain Entry & please include 1 or 2 links to about your diagnosis. Alternatively you can upload a pdf version below this box.

Your Health Focus

Root Cause - You want to discover the root cause of your unwanted symptoms and HEAL Build a Healthy Lifestyle - You want to take control of your health and elevate your life Athletic Performance - You want to optimize your performance through Holistic living

1. Tell me more why you're here. What are your current health goals?

2. Have you had any past expereince with Holistic Wellness. Nutrition, or Movement?

3. If you answered yes to 7, what did you do?

4. Do you have any major health issues that you're aware of? Including food allergies or sensitivities.

Share, Relate, Heal

Share, Relate, Heal

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Email: courtney@theuncommonbalance.com

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Training Interest Form

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