1:1 Coaching Application

01 — Contact Information

Let's start with you.

Your basic information so I can reach you and personalize your experience.

First Name*

Last Name*

Email Address*

Phone Number*

Preferred Pronouns*

How did you hear about Excell Holistics?*

Instagram TikTok Facebook LinkedIn Podcast (Authen-Tea-Cally Nyoka) Word of Mouth / Referral Soul Wellness Gathering Speaking Event Other

02 — Current Challenges

Where are you right now?

There's no wrong answer here. Honesty is where healing begins.

Which areas feel most difficult right now? (Select all that apply)*

Physical / Body Emotional Wellbeing Mental Health / Clarity Spiritual Connection Social / Relationships Environmental Stress Cultural Identity / Belonging Burnout / Exhaustion Career / Purpose

In your own words, describe what's happening.*

03 — Goals & Intentions

Where are you going?

Vision is the beginning of the journey. Tell me what whole looks like for you.

What is your primary goal for coaching?*

What does success look like 3–6 months from now?*

Have you worked with a coach, therapist, or wellness practitioner before?*

Yes No - this is new for me

Application received.

Thank you. I will review your application personally and reach out within 5 business days with next steps.

If anything urgent comes up before then, you can reach me at nyoka@nyokanicolesamuels.com.

— Nyoka

Let's start with you.

Where are you right now?

Where are you going?

The why matters most.

Honoring your commitment.

Application received.