Application for Coaching

The more detailed and thoughtful your responses, the better I’ll be able to understand what’s going on and provide guided feedback tailored to your unique needs. This is your opportunity to share everything that’s been on your mind so I can help you take the right steps toward feeling your best. Take your time, be as honest and specific as possible, and let’s get feeing like you again!

Full Name

Email *

Phone *

Date of birth

Instagram Handle

Are you currently on birth control? If yes which one? *

Do you have any children? If yes please list their ages *

Do you have any current medical conditions? If so, please share how it affects you and anything I should know. Remember, to always check with your physician before making any lifestyle changes. *

What does a typical day of eating look like? What is your biggest struggle? (over eating, cravings) *

Are you experiencing anything that makes you believe your hormones are off? (fatigue, low sex drive, anxiousness, hair loss etc) *

Tell me about your cycle. Is it regular, irregular, do you have heavy days, clotting, PPMD? *

How often do you have bowel movements? Please describe the consistency (e.g., hard, soft, loose, etc.) and any other characteristics you notice (e.g., color, frequency, discomfort). *

Are you on birth control? If yes please share which one and for how long *

Please list any medication you are currently on. *

If you have labs from the last 60 days please upload or email to brenda@brendabreland.com with "Labs: Your Name" as the subject line

What goals are you looking to achieve in the next 6 months? *

Is there anything else you feel I need to know?

Do you have a support system in this journey? Check all that apply *

All me I got this

Spouce/partner 100% supports me and want me to feel better

Spouce/partner is skeptical but will always support me

Spouce/partner doesn't really support me on this journey

No support just me and you girl

What is holding you back from reaching this goal? *

Would you like to learn more about how to work with me? *

Yes, but nervous

Yes I need this now!

Unsure but would love to chat

No just want your thoughts

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