MLH Health and Wellness Survey

Full Name

First NameLast Name
E-mail*
1. What do you consider your biggest health and wellness challenge is right now? Choose all that apply.*

Weight ManagementSugar AddictionChronic PainLow EnergyAnxietySelf-esteemMood SwingsEndless CravingsDigestive IssuesInsomniaEmotional EatingBrain FogLow Immune systemOther
2. What do you feel is the biggest obstacle holding you back from overcoming your pain points? Choose all that apply.*

TimeBurned out, OverwhelmNo support from friends or familyNo support from a wellness or health professionalToo much conflicting information out there and don't know where to beginTried before and failed so afraid to attempt it againDon't know what to eat or cook, need recipesKnow what to do, but hard to implement into daily routineOther
5. What is your biggest frustration or fear when it comes to your health and wellness goals? I want to know!
3. What are some of your favorite activities? How deep is your nerdism?

AnimeDnDVideo GamesMusic (Playing or Listening)Mechanic/Vehicle TuningCosplayWriting (Poetry, books, articles)Reading (Poetry, books, articles)Programming or codingLego BuildingElectronics and RoboticsMovie AddictTV Show AddictDrawing or IllustrationPhotographyComic BooksBoard GamesLanguage LearningOther
6. Would you like to schedule a 30-minute strategy call session with me (at no cost to you) to take the next step in overcoming your health and wellness challenges? This will give us an opportunity to talk and for you to learn more about what I do and how you will benefit greatly!*

YesNo
If you replied "Yes" to the above question, upon this form's submission, you will be redirected to schedule your free strategy session call! Prepare yourself for positive changes!
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