Client Coaching Discovery Form

Menopause Mindfulness Health & Wellness Questionnaire

I am so excited and would love to support you through this peri - post menopausal stage of life, help you to grow into the healthiest version of you
Hi, I am so happy to have you here!

Please be as open and honest as you can when completing this form. This will really help me find the best way to individually support you on this journey. All information is fully confidential and will not be shared. I look forward to recieving your completed form and speaking to you soon ❤️

Huge love
Name

First NameLast Name
Confirm E-mail
Phone Number

Area CodePhone Number
What would you consider yourself as?
If not sure, what makes you say that?
Have you had any coaching before for menopause? If yes what was involved?
Are you currently taking any HRT? (Hormone replacement therapy) If yes, what are you taking and how much? You can also include any supplements in here that you take
What are your top 3 health struggles or goals right now? Please describe them
Are you experiencing any of the following? Tick all that apply
What areas of your life do you feel you need support with?
Has your skin changed during this stage of your life? If so how and what changes have you noticed?
What would you want to get out of me as your coach?
I would love to help and give you support in being the most confident and healthiest version of yourself during what can be a really challenging time. Please tick all that apply
Do you think you have friends or family that would benefit from some Menopause Support Coaching?
Is education and training something you think your employer would benefit from
Is there anything else that you would like me to know about you?
Should be Empty:

Menopause Mindfulness Health & Wellness Questionnaire