Online Coaching Consultation
This assessment will help us set goals that will help You reach your goal. #LETSGETBETTER
Full Name
First Name
Last Name
E-mail
example@example.com
1. What do you consider your biggest health and wellness challenge is right now? Choose all that apply.
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Chronic Pain
Low Energy
Losing Weight
Time Management
Can't Focus, Scattered Attention
Brain Fog
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
Too much conflicting information out there and don't know where to begin
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
4. What are you interested in learning? Choose all that apply.
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How to plan healthier meals/recipes/shopping lists
How to make healthy habits stick
Virtual Fitness Programs you can do at home
How to lose weight and keep it off
Time-saving healthy tips for busy people
Other
6. Would you like to schedule a 20-minute Wellness Coaching Session with me (at no cost to you) to ask you more questions about your health and wellness challenges? This complimentary session is limited to the first 10 people who complete the survey.
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Yes
No
If you replied yes to the above question, please let us know best time to reach you and your phone number.
Phone Number
Submit
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