Lifestyle Wellness Client Qualification

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Name* This field is required.
First Name
Last Name
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E-mail
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Phone Number* This field is required.
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How would you describe your energy levels?* This field is required.
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2
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5
Terrible
Amazing
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How would you describe your stress levels?* This field is required.
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2
3
4
5
Terrible
Amazing
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What are 2-3 goals you would like to accomplish over the next couple of months? Be as detailed as possible.* This field is required.
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What does an improved lifestyle look like for you?* This field is required.
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Do you exercise?* This field is required.
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Not at all
Regularly
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Do you have any wellness concerns? (select all that apply)* This field is required.
Work-life balance
Stress
Sleep quality
Healthy eating & nutrition
Physical fitness
Self care practices
Chronic disease prevention
Toxic home space
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What are your current challenges?* This field is required.
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What is your ideal outcome?* This field is required.
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What are your current efforts to feel better and improve your lifestyle? If nothing at the moment, it's ok to say that.* This field is required.
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Have you personally worked with a coach before?* This field is required.
Yes
No
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Which coaching program would you prefer?* This field is required.
WELLNESS COACHING: VIP Day Intensive (6 hours of 1:1 intensive coaching session and co-creating a 30-60 day action plan for you to follow independently. The 6 hours can be over one or two days.)
WELLNESS COACHING: 6-week program (6 weeks of 1:1 coaching sessions and personalized guidance to support your journey to make progress toward your specific goal.)
FITNESS TRAINING: In-Person Program (in-person fitness training with a personalized plan to help you reach your fitness goals.)
FITNESS TRAINING: Virtual Program (virtual fitness training with a personalized plan to help you reach your fitness goals.)
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What budget range are you comfortable with for the coaching program? (Understanding your budget allows us to tailor the coaching experience to your needs and priorities.)* This field is required.
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Working with Kaamilya is an investment. Do you have the time, energy, and resources to invest in working with Kaamilya right now?* This field is required.
Yes, 100%!
No, not yet.
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Anything else you want to share?
Should be Empty: