Su + Soul Personalized Wellness Questionnaire
Thank you for trusting me to be part of your wellness journey. This form helps me better understand your current lifestyle, goals, and habits so we can design a personalized program that supports your whole self: body, mind, and soul. Please answer with ease, there are no right or wrong responses.
Name
*
First Name
Last Name
E-mail
*
example@example.com
Movement
This part explores your current activity level, preferences, limitations, and goals to create an intentional movement plan that supports your body.
On average, with your current lifestyle, how many days a week does movement realistically fit in?
Once or twice a week
More than 3 or 4 times a week
I can allocate time for movement almost every day
I don't have time for movement
What feels hardest about movement or wellness right now?
Consistency
Time/Scheduling
Budget
Support System
Skills/Knowledge
Anxiety
Lack of Motivation
When do you feel most energized? Are you a(n):
Early Bird (6.30 am)
Mid Morning Enthusiast (8-10 am)
Early Afternoon Flexer (4-6 pm)
Late night owl (6-9 pm)
Variety is the spice of life (I like to mix it up)
What type of movement(s) feels the most supportive nowadays?
Strength // Weight Lifting
Mobility
Yoga Flow
Pilates
Cardio (running, cycling, walking)
Not sure
Do you have any aches, pains, or tension in any part of your body that I should be aware of?
Your Goals
What do you want us to achieve together: What are your top 2-3 specific lifestyle, strength & nutrition goals?
*
Final Details
Preferred Support Between Sessions:
Text/Voice notes
Weekly check-ins
Video form review
Not sure
Open to breathwork/somatic tools?
Yes
No
Maybe
How many days per week are you available for sessions?
Preferred session times (morning, mid-day, evening)
Let's Chat
Book a complimentary 30 Minute Clarity Call with me to chat about your answers and plan our next steps. Submit your form, pick a time that works best for you. Looking forward to connecting!
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