wellness coaching intake form
Thank you for being here. 🤍This is space for women who are ready to feel more connected to their bodies, their health, and themselves — without pressure, and from a place of compassion.My approach to wellness is rooted in balance, and the belief that lasting change doesn’t have to come from being harder on yourself. Together, we’ll explore what you need and create supportive, realistic steps that fit into your life.This short form is a chance for me to get to know you, understand where you are right now, and learn what kind of support you’re looking for.There is no judgement here. Just be honest, be yourself, and know that you’re already taking an important first step.
let's start getting to know each other
what is your preferred name?
what is the best email address to reach you?
*
example@example.com
what is your preferred way to connect?
email
phone call
text
video call
what made you interested in wellness coaching at this point in your journey?
*
where are you right now?
what areas of your well-being would you most like support with? check as many options as you feel align with how you are feeling.
nutrition & nourishing my body
energy & fatigue
stress management
sleep & rest
movement & exercise
mindset & self-talk
confidence & body image
creating healthy routines
emotional well-being
work/life balance
feeling more connected to myself
Other
is there anything else you'd like me to know? If you said "other" above, feel free to go more in depth with how you're feeling here.
if you could change or improve 1–3 things about your health or well-being over the next few months, what would they be?
let's go a little deeper
what do you feel is getting in the way of you feeling your best?
what has felt hardest to maintain or stay consistent with?
when you imagine feeling your healthiest and most balanced, what does that actually look and feel like for you?
how can I best help you?
what kind of support are you hoping for? select as many as you feel aligned with.
gentle accountability
someone to help you create a realistic plan
guidance around nutrition
help creating sustainable habits
mindset support
encouragement and motivation
someone to listen & help me work through obstacles
education and practical tools
i'm not completely sure yet - but want to explore more!
thank you for being here.
i will reach out to you via the contact information you provided within the next few days.
Submit Intake Form
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