Health Coaching Intake Form

What Do You Want To Change?
How, specifically, would you like your habits, your health, your eating and / or your body to be different?
Out of all the changes you'd like to make, which ones feel most important / urgent?*
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Have you tried anything in the past (or recently) to change your habits, your health, your eating and / or your body? If so, what?
Which of those things worked well for you and why? (Even just a little bit and even if you might not be doing them right now.)

Which of those things didn't work well for you and why not?
If you were to consider maybe making more changes to your habits, your health, your eating and/ or your body, what might those be?
Until now, what has blocked you or held you back from changing these things?

What Do You Want?