Introductory Holistic Health Consultation Survey

Holistic Health Consultation Survey

(1) Fill out, complete & send your survey

(2) Call 808-212-5824 to schedule your Free 20 minute Introductory Consultation with Marjy Berkman,

Welcome Friend, to your bold steps forward on your own unique path of healing and clear skin.

From my Book: Psoriasis Free and Clear...

"For me, my skin has always been my messenger, guiding me toward empowerment. From age nineteen to age forty-two, I had psoriasis on my body—thick, red patches that launched me on an epic health journey. Then the psoriasis disappeared.

Psoriasis Free and Clear is not only about psoriasis and the steps you can take to help clear your skin but also about the massive potential that we have as humans to transform our lives. It is about how to thrive through excellent nutrition and connection to the spirit within. If you have psoriasis, this book can change your whole viewpoint of this disease and why it is in your life. It will offer you tangible tools and tips to help heal your body."

I look forward to receiving your completed survey and to our time together during our Free 20 minute Introductory Wholistic Health Coaching Consultation.

Marjy Berkman
Author, Certified Clinical Herbalist,
Certified Nutritionist, Raw Food Chef

Please take your time completing your Comrehensive Holistic Health Consultation Survey below. In our 20 minute introductory holistic heath coaching consultation, based specifically on the information you provide in your survey, we will work together to discover which strategies you can employ first to help meet the health results you desire.

Once your consultation with Marjy is complete, we'll provide you with several available options for ongoing coaching and for a customized, comprehensive plan for vibrant skin and health.

Name (We will never share, sell or rent your information!)

First Name Last Name

Email

example@example.com

Phone Number (We will text confirm receipt of your completed survey, and text to remind you 24 hours before your scheduled intro session.

Area Code Phone Number

Please describe your specific skin challenge, & how long have you had this challenge?

What are you aware of that aggravates your issue?

What are you aware of that improves your issue?

How would you characterize your nutritional status? IE paleo, vegetarian, keto, standard American, etc. Please also list nutritional supplements you take daily.

What natural approaches are you currently using?

Please state clearly what your ultimate health goals are.

What are your challenges in achieving your ultimate health goals?

Besides successfully achieving your ultimate health goals, what is your greatest dream or life goal?

(Excluding your current health challenges) What are your challenges to achieving your greatest dream or goal?

On a scale of 1 – 10, 10 being the most willing, how willing are you to change your current lifestyle and or habits to achieve clear skin & your ultimate health goals?

What areas do you feel you would benefit the most from having regular support and accountability?

What to eat to support your healing. What foods to avoid to support your healing. Supplements for healing Skin. How to successfully commit healing strategies. Tools & practices for your Self Empowerment. Tools & practices for your Self Love & Appreciation. Tools & practices for the Law of Attraction All of the above.

Please list any of your meditation or spiritual practices?

What are your average daily stress levels on a scale of 1 to 10?

Are you ...

Generally focused on and motivated by your visions of future outcomes ? Generally focused on and motivated by current challenges, deadlines? Generally concerned with avoiding past mistakes?

Do you experience overwhelm...

Often Rarely Occasionally Always Never

What is your most common and frequent emotional states during the course of your day.

Describe as many as 3 things you do, have done, or desire to do that you would love to have more of in your life. What captivates you and your attentions? What gives you the most joy? What simply curls your toes?

ONE: What I love and would love more of in my life

TWO: What I love and would love more of in my life

THREE: What I love and would love more of in my life

Congratulations for completing your Introductory Holistic Health Consultation Survey.

Your next steps...

Click the submit button below

Call Marjy Berkman @ 808-212-5824 to schedule your free 20 minute Introductory Holistic Health Consultation Session.

Once your free consultation with Marjy is complete, we'll provide you with several available options for ongoing coaching and for a customized, comprehensive plan for vibrant skin and health.