Wellness Evaluation
Discover a comprehensive way to care for your body & your life.
Full Name
First Name
Last Name
E-mail
1. What do you consider your biggest health and wellness challenge is right now? Choose all that apply.
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Low Energy
Anxiety
Losing Weight
Time Management
Sugar Addiction
Endless Cravings
Digestive Issues
Insomnia
Emotional Eating
Brain Fog
Low Immune system
Other
2. What do you feel is the biggest obstacle holding you back from overcoming your pain points? Choose all that apply.
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Time
Burned out, Overwhelm
No support from friends or family
No support from a wellness or health professional
Tried before and failed so afraid to attempt it again
Don't know what to eat or cook, need recipes
Know what to do, but hard to implement into daily routine
Other
3. What are you loving about your life right now. What's not so hot?
4. What do you want to get out of coaching? Don't be afraid to say the big goal or goals you are secretly hoping will happen.
5. What is your biggest frustration or fear when it comes to your health and wellness goals? How do you take care of yourself?
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6. What are your super strong points? What do you think needs tweaking?
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7. How does your inner voice/mindlessness sabotage you?
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8. What talents do you have that you are not using right now?
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9. Are you getting paid for something you love?
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10. Is there something that you really want to tell me? A question or area you hope I won't ask you about, but secretly you want me to?
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Would you like to schedule a 30-minute Wellness Coaching Session with me (at no cost to you) to ask you more questions about your health and wellness challenges? I’ll also allow time at the end of our call to help you find one easy solution you can implement to help you with your health and wellness challenges. This is a complimentary session.
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Yes
No
If you replied yes to the above question, please let me know best time to reach you and your phone number from Monday - Friday. I will contact you to confirm your appointment time.
Appointment
Phone Number
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