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Schedule a consultation with a Certified Fibromyalgia Coach^® to explore how we can help you feel better faster.

Consultations are filled on a first come, first served basis and openings are limited. During your private consultation, your coach will provide you with suggestions you can take action on right away and explore new options to help you take back control of your life and health.

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Name

This field is for validation purposes and should be left unchanged.

Name*

First Last

Phone*

Email*

The email you provide here will be how our office will get in touch with you regarding your request.

Enter Email Confirm Email

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

How did you hear about us?*

Have you ever met with a coach about your fibromyalgia?*

I have met with a coach for a consultation only.

I have worked with a coach on my fibromyalgia.

No, I have never talked to a coach about my fibromyalgia.

Would you like to receive notification of new training programs and our monthly newsletter?*

Yes

Important Information

During your consultation, we will help you discover if Fibromyalgia Coaching will help you reach your goals. The questions below will help us determine which of our trained coaches will be the best possible match for you. You will be able to select the coach you'd like to work with after you submit this form.

How long have you been living with fibromyalgia symptoms?

What is your age?*

Since you are under 18, you will need to have a parent or legal guardian present on this first call. Future coaching calls may be private.*

Name of parent or legal guardian who be on this call?

Parent or legal guardian's email*

The email you provide here will be how our office will get in touch with your parent or legal guardian regarding your request.

Enter Email Confirm Email

What are your preferred pronouns?*

Female: "Wish her a happy birthday!"

Male: "Wish him a happy birthday!"

Neutral: "Wish them a happy birthday!"

What is your current employment status?

Which would you prefer?

Female Coach

Male Coach

No preference

What is the biggest challenge in your life right now?

What would you like your coach to help you work on first?

After completing your coaching sessions, what do you expect will be different in your life?

Give us the short version of your fibromyalgia story so that we can better understand your situation:

What other things have you invested in to try to improve your fibromyalgia?

Why is now the right time for you to invest in solving this problem?

Do you have any of these special concerns?

Many of our Coaches and Advisors have specific areas that they specialize in. Please mark any and all that would be important for your Coach or Advisor to know how to address:

We have found that some topics are hard for clients to bring up. Therefore, we ask these same questions of everyone.

Have you ever had thoughts of killing yourself?*

Yes

Have you attempted suicide in the past?*

Yes

Signature*

By typing your name below, you are digitally signing this application and verifying that all of the information you have provided is complete and factually correct.

Parent or Legal Guardian's Signature*

By typing your name below, you are digitally signing this application and verifying that all of the information provided is complete and factually correct. You are also agreeing to join the applicant at their consultation.

Privacy Policy

In summary, we will respect and keep your information private. By submitting this request, you agree to our Privacy Policy and understand that your information will be shared with our coaches in order to provide you with the consultation you have requested.

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