reveal-her

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How does my mood and feelings influence my lifestyle routine?* This field is required.Reflect on your current habits when answering this question. For instance, you might picture your morning routine, religious and spiritual, eating and drinking, caring for others, purchases, household activities, personal care, and sleep. With all of the responsibilities you have or have had, think about the impact your mood and feelings have on your choices.
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2
Am I Walking By Faith?* This field is required.Please, answer True of False for the statements listed below.
Please select
Please select
True
False
I make most of my decisions based on my mood or how I feel at the time.
Please Select
Please Select
True
False
I have something/s I would not be willing to give up, if God asked me to.
Please Select
Please Select
True
False
I trust God with all of my finances.
Please Select
Please Select
True
False
I guard my mind from ungodly input. Example: Profane movies, literature, music.
3
Rate Your Current Faith Walk* This field is required.Reflecting on your previous answers, on a scale of 1 - 10 ( 1= Newly Born, 10= Fully Grown) please rate how you view your current walk of faith with the Lord.
Type a number between 1 and 10.
4
What are my priorities in life?* This field is required.Please, list your current priorities. Reflecting on your habits can help when answering this question. For instance, you might picture your morning routine, religious and spiritual, eating and drinking, caring for others, purchases, household activities, personal care, and sleep. With all of the responsibilities you have, think about what you have been putting first in your life.
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5
Is God a priority in my life?* This field is required.Please, answer True of False for the statements listed below.
Please select
Please select
True
False
I read or listen to God's word frequently.
Please Select
Please Select
True
False
I have a group of believers to hold me accountable for my spiritual growth.
Please Select
Please Select
True
False
I don't have friendships or relationships with family that interfere with God's will for me.
Please Select
Please Select
True
False
I make time for God often.
6
Rate Your Current Relationship With God* This field is required.Reflecting on your previous answers, on a scale of 1 - 10 ( 1= Newly Born, 10= Fully Grown) please rate how you view your current relationship with God.
Type a number between 1 and 10.
7
What are my health and wellness goals?* This field is required.Please list all of the goals that come to mind for your life (spiritual, fitness, finances, relationship, health, etc.). Next, explain what you think supported you in successfully achieving specific past goals. Finally, explain what you think kept you from obtaining specific goals in the past.
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8
Does my lifestyle honor God?* This field is required.Please, answer True of False for the statements listed below.
Please select
Please select
True
False
I am not careless with my body and my health.
Please Select
Please Select
True
False
I don't engage in any habits or activities that are harmful to me.
Please Select
Please Select
True
False
I excel at practicing self-discipline
Please Select
Please Select
True
False
God is involved in my self-care routine
9
Rate Your Wellness* This field is required.Reflecting on your previous answers, on a scale of 1 - 10 ( 1= Newly Born, 10= Fully Grown) please rate how you view your current wellness.
Type a number between 1 and 10.
10
What are my Obstacles / Challenges?* This field is required.Please, explain what challenges you are facing that you think are preventing you from reaching your wellness goals.
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11
Are you comfortable selecting a payment within the sliding-scale range that reflects your current financial situation?* This field is required.Finally, these last few questions are to assist your Life Well Coach in making a final decision about the cost of your tailored Wellness Program Package. If you choose no, your Wellness Package will be the advertised cost with payment options, that will be presented to you after your consultation and you can skip answering the questions on the following page. If you qualify for the sliding-scale range, your cost will be determined after your first virtual consultation. Thank You!
YESNO
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Key Questions To Determine Appropriate Payment LevelIf you answered yes to the previous question please, answer the questions below. If your financial situation qualifies for any savings there will be an email detailing your package cost and savings.
Do You Qualify For Any Food and Nutrition Government Assistance Program?
Do You Qualify For Any Food and Nutrition Government Assistance Program?
Yes
No
Waiting on Approval
I Don't Know
*Money spent each month. Ex: rent, loans, utilities, car insurance...
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Please Provide Your Contact Details * This field is required.Thank you for filling out this form and investing in your health and wellness. Your Life Well Coach will be in touch.
Your Full Name
Please enter your email
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