if we're a good fit to work together.

If you had to choose ONE, what's your #1 "go-to" source about HEALTH and WELLNESS, or quitting smoking / vaping?

Science

Less from science; more from "what works" wherever it comes from

My friends

Inernet

Other (please describe in the question marked with a ** below)

What # 1 HEALTH and WELLNESS concern / issue do you have right now? (They can be totally unrelated to nicotine use.)

Weight issues

Lack of energy

Sugar addiction

Issues with healing

Emotional issues

Relationship issues

nicotine use is my #1 issue

One-on-one transformational health coaching requires a commitment of some time, and a financial investment. I'm...

100% committed - both my time AND financial investment.

able to commit MOST days.

not sure where I stand or what I want right now but I want to explore health coaching.

I believe smoking / vaping is

mostly an addiction

mostly a habit

both a habit + addiction

a habit and addiction AND MUCH MORE

ALL members of my household will

be 100% supportive of my commitment to Nico transformational health coaching

be LESS THAN 100% supportive

be neutral - neither supportive or unsupportive

I'm the only one in my household

Do you want me to collaborate with your health care provider while you're taking this course or in one-on-one coaching?

Yes. Please send me the appropriate Consents & Releases by email when the time comes.

No. I feel confident in doing this on my own and take full responsibility for doing so.

Not sure yet.

I understand the information collected in this form complies with the EU's GDPR

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