Client Discovery Form

Welcome to &Well

I am so proud of you for showing up for yourself and dedicating time towards your health and wellness journey. The Client Discovery form allows you to capture the key areas of concern and your readiness for change. It captures everything we need to have a productive conversation. Please set aside 10 minutes and write down as much as you would like. Take time to reflect. I look forward to speaking with you soon.
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.

Rate the below areas of health*

Pick an area in your life that is your biggest concern when it comes to your health. What is not working? Physical or non physical. Feelings, thoughts, people, situations.*
From that same area, what would you like it to look like for you in 6/12 months time?*
Level of readiness for change*

1

2

3

4

5

6

7

8

9

10

1 is Resistant, 10 is Ready
Level of commitment to take action*

1

2

3

4

5

6

7

8

9

10

1 is Passive, 10 is 100% Action!
Should be Empty:

Welcome to &Well