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1
Welcome! I am so excited that you are here. Tell us who you are.
First Name
Last Name
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2
What is your email?
example@example.com
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3
Do you know what the Healthstyle Emporium is? If so how did you hear about us?
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4
What are your health concerns?
Immune support
Weight management
Create/maintain healthy habits
Acne/skin concerns
Digestive issues
Heart health
Specific medical condition
Brain health/support
Other
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5
Have you ever worked with a health coach before? If so, can you tell me about your previous experience and what you are currently looking for? If not, what made you interested in working with one?
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6
What is your main health goal for the next 6-12 months.
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7
Do you have any questions for me or anything specific you would like me to know?
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8
How is the best way for me to contact you? Email, phone or social media? Please put that information below.
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