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26
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1
First Name
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2
Last Name
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3
Phone Number
Please enter a valid phone number.
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4
Have you ever worked with a coach before?
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5
On a scale of 1-10 how high is your stress/anxiety levels?
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6
On a scale of 1-10 how well do you sleep?
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7
What is your current daily or weekly practices that help decrease stress?
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8
Do you experience any physical body pain? If yes, where?
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9
How do you normally manage or process emotions?
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10
What is your inner monologue like?
Do you find yourself oriented towards positive or negative thoughts?
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11
What is your current relationship status?
If single, skip the next two questions.
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12
Have you shared with your partner that you are participating in this program?
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13
Is your partner also invested in self-development, healing or personal growth?
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14
Do you exercise?
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15
How often?
Rarely
Often
Sometimes
Consistently
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16
Do you have wearable technology? If so, which one?
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17
What is your current/average HRV
Heart Rate Variability
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18
What is your relationship like with your body?
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19
What is your definition or connection to Higher Energy.
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20
What are your 3 biggest challenges right now?
Ie. health, relationship, career, purpose
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21
What is your relationship like to your past?
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22
What are three things you'd like to achieve from this process?
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23
How committed are you to creating change in your life?
Scale 1-10
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24
How ready are you to take responsibility of your health?
Scale 1-10
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25
This program requires at least a 20-30-min daily practice that you will commit to on your own. Are you ready to make that commitment to yourself?
I will be walking through the practice and give you all the tools you need.
YES
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26
Is there anything else that you would like me to know before our call?
Now is your chance...
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