Ascencion Coaching Questionnaire

Full Name

First NameLast Name

Gender

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Age

years

Height

cm

Weight

IB

What do you do for a living?

Magic

Whats the activity level at your job?

Other

How many pounds would you like to lose/gain, or what is your health goal?

What motivates you to seek a change in your lifestyle?

Do you have any current health concerns or conditions ?

How do you feel about your current emotional and mental well-being ?

Other

Do you experience high levels of stress, anxiety, or low burst of energy?

What practices, if any, do you use to manage your emotional and mental health ?

Are you interested in exploring spiritual practices as part of your wellness journey?

How would you rate your connection with your higher self or spiritual guides ?

Other

Are you interested in meal planning to support your wellness goals ?

Other

Please rate your readiness to start your ascension process.

Is there anything else you’d like to share about your wellness journey or specific needs ?

Are you interested in incorporating any of the following into your routine?

How do you prefer to be contacted?

Other

I am so excited that you decided to reach out to me to help you with your ascencion goals! I can't wait to work with you! I'll reach out within 24 hours Monday- Friday and no holidays!

Intake Form!