Apply - The Second Half Project

1 Personal

2 Goals

3 Background

4 Commitment

Personal Information

Email *

Full Name and Surname *

Contact Number (WhatsApp) *

Date of Birth *

Gender *

Male

Female

Goals

What are your main health/body goals right now? *

Lose weight

Improve body composition

Stabilize energy levels

Reduce inflammation

Enhance mental clarity

Reduce cravings

Improve overall health

Other

What are the biggest health/body challenges you are currently facing? *

Background

Have you tried improving your health or losing weight before? *

Yes, many times

Yes, a few times

No, this would be my first serious attempt

If yes, what have you tried?

Are you currently following any specific diet? Please specify. *

Are you currently diagnosed with any medical conditions? *

Yes

Please specify.

Are you currently taking prescription medication? *

Yes

Please specify.

Are you currently taking any supplements? *

Yes

Please list all.

Do you have any known allergies or food intolerances? *

Yes

Please specify.

Have you had recent bloodwork done? *

Yes

How would you rate your overall health right now? *

Poor

Fair

Good

Very Good

Excellent

Not sure

Current weight (Optional)

Height (Optional)

Commitment

Why do you want to make this change now? *

Are you willing to make meaningful lifestyle changes to improve your health? *

Yes

I'm open to it but unsure

Not really

If this program is successful, what would your life look like in 3 months? What would have changed? *

On a scale of 1-10, how ready are you to commit to lifestyle changes? *

Is there anything else you'd like to add or mention?

Disclaimer / Consent

By submitting this application, I acknowledge that The Second Half Project is a health coaching service and does not replace medical advice, diagnosis, or treatment from a qualified healthcare professional. Any guidance provided is for educational and lifestyle-support purposes only. I understand that individual results may vary, that I am responsible for my own health choices, and that I should seek appropriate medical advice where needed.

Do you acknowledge and agree to the above disclaimer? *

Yes, I have read and understood the above disclaimer.

Apply for The Second Half Project

Personal Information

Goals

Background

Commitment