Concierge One-on-One Interest Form

Thank you for your interest! We look forward to learning more about you and your needs.

Please complete this short form and a member of our team will be in touch within two business days. Stay on the lookout for an email from info@hookywellness.com.
First Name*
Last Name*
Email*
example@example.com
What is your role/title?*
What is the name of your employer?*
What sector/industry most closely describes where you currently work?*
One a scale of one to five, how would you rate your level of burnout. One (1) is "I'm trying to prevent burnout." Five (5) is "I am currently dealing with burnout."*

1

2

3

4

5

1 is Trying to Prevent, 5 is Dealing with
In what area are you are currently struggling when it comes to burnout relief. Select all that apply.*

Determining if you’re dealing with burnoutIdentifying personal needs and support resourcesUnderstanding how to stop burnout from coming backRest and relaxationHabits and routinesCreating and enforcing boundariesBalancing work expectations and personal well-beingSupporting othersAccountability for self-careCommunityOther, please explain
How is this struggle currently affecting your life?*
What obstacles are getting in the way of your relief?*
Why have you decided that now is the time to invest in your relief?*
If you could wave a magic wand, how would you describe what your relationship with work and your personal wellness look like?*
What is your primary goal in seeking burnout relief?*
Do you have any of the following support? Select all that apply.*

TherapistCareer CoachRegular physical fitness routineStress outletReliable community of friendsNone of the above
How were you introduced to Hooky Wellness?*

ReferralLinkedInInstagram/FacebookPress or podcast interviewsA member of the Hooky Wellness teamGoogleHooky Wellness WebsiteUnsure/Don’t recallOther, please specify
Please share the person or business or platform that introduced you to Hooky Wellness.*
If you don't remember, just say, "I don't remember."
May we add you to our newsletter list?*
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