Client application- Jenn Paet

Ready to start your journey? Let's Chat about it!

Fill out this form in as much detail as you feel comfortable with. This allows me to learn as much as possible about your goals before our call. Once you have submitted the form I will reach out to schedule a 30 minute call, we will discuss your goals, current lifestyle and my coaching. The goal is to see if we are a good fit for a coaching relationship and if I can help guide you to your goals.
Name

First NameLast Name
Email
example@example.com
Date

MonthDayYear
Today's Date
Phone Number
Format: (000) 000-0000.
Age

MonthDayYear
Date
How did you hear about me?
If you were referred, name of person who referred you.
Main Health Goals
Why are you reaching out to a me today? What Specific health, wellness, and lifestyle changes would you like to make?

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What have been your barriers or challenges in creating these health changes for yourself?

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How do you feel working with a health coach will help you achieve your goals?

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Use this space to provide anything else you feel that would benefit me helping you to achieve your goals.
On a scale of 1-5 rank your level of readiness with regard to learning new ways of eating, moving and living.
On a scale of 1-5 how committed you are to making changes that feel uncomfortable, different or new?
On a scale of 1-5, how willing are you to communicate openly with your health coach as an equal partnership, and feel confident to ask for what you need?
Thank you for sharing your goals and dreams with me for your future. I am very excited and honored to explore them with you.
jenndjpaet@gmail.com

https://jenndjpaet.wixsite.com/jennpaethealth

573-228-1592

https://www.facebook.com/jenn.paet.7

IG - jenn_paet_healthcoaching
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Ready to start your journey? Let's Chat about it!

Main Health Goals

Thank you for sharing your goals and dreams with me for your future. I am very excited and honored to explore them with you.