Dr.Tosha B
Kinesiologist | Stress Management Practitioner | Women's Fitness Specialist
Consultation Form
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
How did you find me?
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TikTok
FaceBook
Instagram
Other
What are your health and wellness goals?
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What do you think is keeping you from your desired goals?
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On a scale of 1-5, how important are your health goals to you?
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1
2
3
4
5
What are your health challenges?
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Are you suffering with stress? Physical Stress (e.g., injury, illness, fatigue) Emotional Stress (e.g., relationship issues, grief, loneliness) Psychological Stress (e.g., anxiety, fear, self-doubt) Environmental Stress (e.g., noise, pollution, unsafe surroundings) Social Stress (e.g., conflict, peer pressure, social isolation) Financial Stress (e.g., debt, job insecurity, unexpected expenses) Workplace Stress (e.g., deadlines, demanding roles, lack of control) Spiritual Stress (e.g., crises of faith, lack of purpose or meaning)
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Emotional Stress
Psychological Stress
Environmental Stress
Social Stress
Financial Stress
Workplace Stress
Spiritual Stress
Physical Stress
None
What is your discipline level?
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Independent (Need a plan, can do workouts independently)
Need Accountability ( Need in person or virtual coaching)
If you are ready to invest in 1 on 1 transformational coaching and training, select a consultation day and time that works best for you. I can’t wait to speak with you!
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