Coaching Interest Form

Thank you for your interest in wellness coaching with Dr. Peoples. Please complete the information below to help us best serve your needs.

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Name *

First

Last

Phone Number *

Email *

In what city and state are you located? *

What service or services are you most interested in learning about? *

Individual Wellness Coaching Group Wellness Coaching Drop-in Educational Groups

Why are you interested in working with Dr. Peoples? *

Are there any special topics that you would like to see addressed in an educational group? *

Imara Health and Wellness is not in network with insurance. As such, working with us will require an investment in your health. If we can find a solution to help address your health goals, which solution(s) are you willing and/or able to invest in? *

I'm ready to transform my life in 90 days and I want to be supported by a community of fabulous black women as I journey through the process! ($450 investment) I'm looking for one-on-one guidance in a specific area of wellness (Starting at $220 per session) I'm looking to go at my own pace by working through the wellness modules online rather than meeting in real time with the rest of the group ($150 investment) I'm interested in drop-in educational groups on topics that are relevant to my health and well being (Starting at $25 per session) I can't afford anything at the moment but need help finding resources

What else would you like us to know so we can best serve you? *

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