Coaching Intake Form
~ Christian Life Coaching with Nyla ~
All info will remain confidential.
Name
First Name
Last Name
Age
Email
example@example.com
Phone Number
-
Area Code
Phone Number
City & Country
Give me a mini bio of you! Married? Occupation? Kids? Best thing you ate this week? You decide what you want to tell me about YOU!
How did you hear about my health coaching business, Nutrition with Nyla?
Are you open to hearing things from a Christian perspective?
Tell me about your relationship with food, exercise, body image. What is feeling hard?
What are your biggest struggles when it comes to health? This can be about food, exercise, meal planning, digestion, sleep, anything goes! Please be honest, there is no judgment on my end, promise.
How long has this been a struggle of yours?
How is this negatively impacting your life right now?
What are the biggest obstacles in your way to making your desired changes?
Have your tried seeking out help before or tried remedying it on your own? If so, why do you think these techniques didn't work? What was lacking? Also, what was effective and did help you change?
Why motivates you most to make changes to your mindset and/or lifestyle habits? Who else will benefit from these changes being made?
Have you been clinically diagnosed with an eating disorder before?
Yes
No
Not clinically but I showed behaviors of having one
Do you have any medical conditions?
What are you hoping to get out of working together? What are your goals and dreams?
Submit
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