Coaching Application Form

HI, I'm JESSICA
As a Holistic Nutritionist, I've helped hundreds of people break free from the pain and discomfort of IBS. This is the blog that I wish existed back when I was diagnosed with IBS almost two decades ago. Enjoy, comment and share!
YOU MIGHT ALSO LIKE:
SIBO: the culprit of the chronically bloated
Why I don't believe in affiliate marketing
Travel the world on fifteen damn dollars
Tired of IBS controlling your life?
Learn how to manage flares & pinpoint gut triggers with my Holistic Wellness & Nutrition program for IBS.
tell me more

[et_pb_section fb_built=”1″ disabled_on=”off|off|off” admin_label=”Page Title Section” _builder_version=”3.22.7″ use_background_color_gradient=”on” background_color_gradient_start=”#f4f4f4″ background_color_gradient_end=”rgba(244,244,244,0)” background_color_gradient_direction=”270deg” background_color_gradient_start_position=”50%” background_color_gradient_end_position=”80%” background_color_gradient_overlays_image=”on” background_size=”contain” background_position=”center_left” custom_padding=”54px||0||false|false”][et_pb_row custom_padding=”0px|||||” _builder_version=”3.22.7″][et_pb_column type=”4_4″ _builder_version=”3.22.7″][et_pb_text _builder_version=”3.22.7″ text_font=”Open Sans||||||||” text_font_size=”16px” text_line_height=”1.8em” header_font=”Montserrat|600|||||||” header_text_color=”#69384d” header_font_size=”35px” header_line_height=”1.3em”]

The IBS Girl 1:1 Coaching Application

This application is to give me an idea of your health goals, current health struggles and what you are looking for in a coaching experience. There are no wrong answers! Filling out this form does not sign you up for my coaching program. I will be in touch within 24 hours of completing the application form. Can’t wait to connect!

[/et_pb_text][et_pb_contact_form captcha=”off” email=”kurtishurrie@gmail.com” success_message=”Thank you for submitting! I will get back to you as soon as I can.” disabled_on=”on|on|on” _builder_version=”3.22.7″ title_font=”Montserrat||||||||” form_field_font=”Montserrat||||||||” form_field_font_size=”15px” form_field_line_height=”2em” custom_button=”on” button_text_color=”#ffffff” button_bg_color=”#69384d” button_border_width=”0px” button_border_color=”rgba(0,0,0,0)” button_font=”Montserrat||||||||” box_shadow_style_button=”preset2″ custom_padding_phone=”15px||15px|” custom_padding_last_edited=”on|phone” disabled=”on”][et_pb_contact_field field_id=”What_is_your_first_and_last_name?” field_title=”What is your first and last name?” _builder_version=”3.22.7″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”What_are_your_preferred_pronouns?” field_title=”What are your preferred pronouns?” required_mark=”off” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_age?” field_title=”What is your age?” _builder_version=”3.22.7″ form_field_font=”||||||||”][/et_pb_contact_field][et_pb_contact_field field_id=”Please_provide_your_email_address.” field_title=”Please provide your email address.” field_type=”email” _builder_version=”3.22.7″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”Please_provide_your_telephone_number.” field_title=”Please provide your telephone number.” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”Which_city_are_you_located_in?” field_title=”Which city are you located in? ” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_main_health_concern?_Please_include_a_list_of_what_symptoms_are_bothering_you_the_most.” field_title=”What is your main health concern? Please include a list of what symptoms are bothering you the most.” field_type=”text” fullwidth_field=”on” _builder_version=”3.22.7″ form_field_font=”||||||||”][/et_pb_contact_field][et_pb_contact_field field_id=”How_long_have_you_been_experiencing_this_health_concern?” field_title=”How long have you been experiencing this health concern?” field_type=”text” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_goal_for_working_with_me?” field_title=”What is your goal for working with me?” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”Are_you_working_with_any_other_practitioners_for_the_same_health_concern?” field_title=”Are you working with any other practitioners for the same health concern? ” field_type=”text” fullwidth_field=”on” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_type_of_client_are_you?_There_is_no_%22wrong%22_answer_here!” field_title=”What type of client are you? There is no %22wrong%22 answer here! *” field_type=”radio” radio_options=”%91{%22value%22:%22I want guidelines to follow but like flexibility in choosing what to eat, when and how.%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22I want full structure and to be told exactly what to eat, when and how.%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Other%22,%22checked%22:0,%22dragID%22:1}%93″ _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”I_have_clients_check_in_with_me_as_they_need_via_email_or_text._Are_you_comfortable_with_reaching_out_to_me?” field_title=”I have clients check in with me as they need via email or text. Are you comfortable with reaching out to me? ” field_type=”radio” radio_options=”%91{%22value%22:%22No, I need accountability and for you to check in with me regularly.%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Yes, I will reach out to check in with you as needed.%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Other%22,%22checked%22:0,%22dragID%22:1}%93″ _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”Communication” field_title=”Open communication, connection and vulnerability play big roles in a successful coaching relationship. There can also be some trial and error as we work through the healing process and find what works best for you in terms of food and lifestyle. How committed are you to this? *” field_type=”radio” radio_options=”%91{%22value%22:%221%22,%22checked%22:0,%22dragID%22:-1},{%22dragID%22:0,%22value%22:%222%22,%22checked%22:0},{%22dragID%22:1,%22value%22:%223%22,%22checked%22:0},{%22dragID%22:2,%22value%22:%224%22,%22checked%22:0},{%22dragID%22:3,%22value%22:%225%22,%22checked%22:0}%93″ fullwidth_field=”on” _builder_version=”3.22.7″ form_field_font=”||||||||”][/et_pb_contact_field][/et_pb_contact_form][et_pb_contact_form captcha=”off” email=”kurtishurrie@gmail.com” _builder_version=”3.22.7″ admin_label=”Coaching Form”][et_pb_contact_field field_id=”What_is_your_first_name?” field_title=”What is your first name?” _builder_version=”3.22.7″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”What_are_your_preferred_pronouns?” field_title=”What are your preferred pronouns?” required_mark=”off” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_age?” field_title=”What is your age?” required_mark=”off” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”What is your email address?” field_type=”email” _builder_version=”3.22.7″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_phone_number?” field_title=”What is your phone number?” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”Which_city_are_you_located_in?” field_title=”Which city are you located in?” required_mark=”off” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_main_health_concern?_Please_include_a_list_of_what_symptoms_are_bothering_you_the_most.” field_title=”What is your main health concern? Please include a list of what symptoms are bothering you the most.” field_type=”text” fullwidth_field=”on” _builder_version=”3.22.7″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][/et_pb_contact_field][et_pb_contact_field field_id=”How_long_have_you_been_experiencing_this_health_concern?” field_title=”How long have you been experiencing this health concern?” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_is_your_goal_working_with_me?” field_title=”What is your goal working with me?” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”Are_you_working_with_any_other_practitioners_for_the_same_health_concern?” field_title=”Are you working with any other practitioners for the same health concern? ” _builder_version=”3.22.7″][/et_pb_contact_field][et_pb_contact_field field_id=”What_type_of_client_are_you?_There_is_no_%22wrong%22_answer_here!” field_title=”What type of client are you? There is no %22wrong%22 answer here!” field_type=”select” _builder_version=”3.22.7″ select_options=”%91{%22value%22:%22I want guidelines to follow but like flexibility in choosing what to eat, when and how.%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22I want full structure and to be told exactly what to eat, when and how.%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Other%22,%22checked%22:0,%22dragID%22:1}%93″][/et_pb_contact_field][et_pb_contact_field field_id=”I_have_clients_check_in_with_me_as_they_need_via_email_or_text._Are_you_comfortable_with_reaching_out_to_me?” field_title=”I have clients check in with me as they need via email or text. Are you comfortable with reaching out to me? ” field_type=”select” _builder_version=”3.22.7″ select_options=”%91{%22value%22:%22Yes, I will reach out to check in with you as needed.%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22No, I need accountability and for you to check in with me regularly.%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Other%22,%22checked%22:0,%22dragID%22:1}%93″][/et_pb_contact_field][et_pb_contact_field field_id=”Communication” field_title=”Open communication, connection and vulnerability play big roles in a successful coaching relationship. There can also be some trial and error as we work through the healing process and find what works best for you in terms of food and lifestyle. How committed are you to this? *” field_type=”select” _builder_version=”3.22.7″ select_options=”%91{%22value%22:%221%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%222%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%223%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%224%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%225%22,%22checked%22:0,%22dragID%22:5}%93″][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=”1″ disabled_on=”on|on|off” _builder_version=”3.22.7″ background_color=”#f1d7d0″ custom_padding=”10px|0px|10px|0px|false|false” global_module=”132″ saved_tabs=”all”][et_pb_row custom_padding=”27px|0px|0|0px|false|false” _builder_version=”3.22.3″ width=”74%” max_width=”74%” use_custom_width=”on” width_unit=”off” custom_width_percent=”74%”][et_pb_column type=”1_4″ _builder_version=”3.19.11″][et_pb_image src=”https://theibsgirl.com/wp-content/uploads/2019/02/IBS-Girl-Logo-Final.png” _builder_version=”3.19.11″][/et_pb_image][et_pb_social_media_follow _builder_version=”3.19.11″ text_orientation=”center”][et_pb_social_media_follow_network social_network=”facebook” _builder_version=”3.19.11″ background_color=”#7c7c7c” follow_button=”off” url_new_window=”on”]facebook[/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=”instagram” url=”https://www.instagram.com/theibsgirl/” _builder_version=”3.19.11″ background_color=”#7c7c7c” follow_button=”off” url_new_window=”on”]instagram[/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=”pinterest” url=”https://www.pinterest.ca/theibsgirl/” _builder_version=”3.19.11″ background_color=”#7c7c7c” follow_button=”off” url_new_window=”on”]pinterest[/et_pb_social_media_follow_network][/et_pb_social_media_follow][et_pb_text _builder_version=”3.19.11″ custom_margin=”-20px||”]

[/et_pb_text][/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.19.11″][et_pb_text ul_type=”none” _builder_version=”3.22.7″ text_font=”Open Sans||||||||” text_text_color=”#FFFFFF” text_font_size=”13px” text_line_height=”0.9em” ul_font=”||||||||” ul_line_height=”1.6em”]

[/et_pb_text][/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.19.11″][et_pb_text ul_type=”none” _builder_version=”3.19.11″ text_font=”Open Sans||||||||” text_text_color=”#FFFFFF” text_font_size=”13px” text_line_height=”0.9em” ul_font=”||||||||” ul_line_height=”1.6em”]

[/et_pb_text][/et_pb_column][et_pb_column type=”1_4″ _builder_version=”3.19.11″][et_pb_text _builder_version=”3.22.7″ text_font=”Open Sans||||||||” text_text_color=”#8f8f8f” text_font_size=”12px” text_line_height=”1.4em” header_2_font=”Montserrat||||||||” header_2_text_color=”#FFFFFF” header_2_font_size=”18px”]

Privacy Policy

Your privacy is important to me.

It is my policy to respect your privacy regarding any information I may collect while operating our website.

I am committed to conducting my business in accordance with these principles to ensure that the confidentiality of personal information is protected and maintained.

[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section fb_built=”1″ disabled_on=”off|off|on” _builder_version=”3.22.7″ background_color=”#262626″ custom_padding=”8px|0px|20px|0px|false|false”][et_pb_row custom_padding=”30px|0px|0|0px|false|false” _builder_version=”3.22.3″][et_pb_column type=”1_2″ _builder_version=”3.19.11″][et_pb_image src=”https://theibsgirl.com/wp-content/uploads/2019/02/IBS-Girl-Logo-Final.png” align=”center” _builder_version=”3.19.11″ max_width_tablet=”62%” max_width_last_edited=”on|desktop”][/et_pb_image][et_pb_social_media_follow _builder_version=”3.19.11″ text_orientation=”center”][et_pb_social_media_follow_network social_network=”facebook” _builder_version=”3.19.11″ background_color=”#7c7c7c” follow_button=”off” url_new_window=”on”]facebook[/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=”instagram” _builder_version=”3.19.11″ background_color=”#7c7c7c” follow_button=”off” url_new_window=”on”]instagram[/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=”pinterest” _builder_version=”3.19.11″ background_color=”#7c7c7c” follow_button=”off” url_new_window=”on”]pinterest[/et_pb_social_media_follow_network][/et_pb_social_media_follow][/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.19.11″][et_pb_text _builder_version=”3.19.11″ text_font=”Open Sans||||||||” text_text_color=”#FFFFFF” text_font_size=”12px” text_line_height=”1.4em” header_2_font=”Montserrat||||||||” header_2_text_color=”#FFFFFF” header_2_font_size=”18px”]

Privacy Policy

Your privacy is important to me.

It is The IBS Girls’ policy to respect your privacy regarding any information I may collect while operating our website.

I am committed to conducting my business in accordance with these principles to ensure that the confidentiality of personal information is protected and maintained.

[/et_pb_text][et_pb_text _builder_version=”3.19.11″ text_font=”||||||||” custom_margin=”||”]

[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]

add a comment

Reply...

back to blog home

Previous Post

Next Post

»

Browse By Category

health

wellness

nutrition

recipes

HELLO

I'm Jessica

and I'm a Holistic Nutritionist who is thriving with IBS. Like you, I needlessly suffered for years with gut issues before I found the root cause of my issues...

read more

Get My 7-Day Debloat Challenge

Includes an easy-to-follow meal plan, grocery list, food guide and recipes designed to help you beat the bloat.

Get the DOWNLOAD

START HERE