Discovery Intake Form
B. Coaching
This will help me gain a better understanding of your needs and expectations. All your information is confidential.
Thanks, Brittany
Name
*
First
Last
Email
*
Phone Number
Please enter a valid phone number.
Have you ever worked with a health coach? If yes, how was the experience?
Do you have any diagnosed health conditions? (Current or recent)
What are your health, wellness, and/or life goals? (try to be specific)
WHY is achieving these goals important and meaningful to you?
What has hindered you and made it difficult to reach your goals? In other words, what challenges and obstacles have stood in your way.
Who has been important in supporting you? (In general and/or in relation to goal)
On a scale of 1-10, what is your current stress level? (10 is high)
On a scale of 1-10, how would you rate your current quality of life today? (10 is high)
What session-style works best for you?
*
In-person
Virtual
Phone
Not really sure
Virtual
A combination
Other
Use this last spot to ask questions or mention anything else you feel is important.
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