Before We Meet
Welcome to the first step in your wellness journey! This Clarity Consultation Form helps us understand your unique needs before we connect. Take a few moments to share your goals and challenges, and we'll reach out within 24 hours to schedule your consultation.
Full Name
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Email
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Phone Number
Please enter a valid phone number.
Preferred contact method:
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Phone
Email
SMS/Text
How'd you hear about us?
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Please Select
Facebook
Pinterest
Family/Friend Referral
Google Search
Mother Woman Restored
FEMMENIN
Other
Other (please specify):
I am ready to (check all that apply):
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improve physical performance/appearance
develop a healthier relationship with food
transform limiting behavior patterns
create sustainable holistic wellness practices
manage chronic stress and pain
reconnect with body awareness and intuition
establish consistent self-care routines
Other
List any issues you wish to deal with and what you hope to achieve in the coaching setting:
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Current Wellness Challenges
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Inconsistent healthy habits
Chronic stress, anxiety, or overwhelm
Physical pain, discomfort, or limited mobility
Emotional eating patterns
Low energy or fatigue
Sleep difficulties
Difficulty maintaining motivation
Other (please describe)
What's your biggest
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What's your biggest wellness challenge right now?
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What have you tried before that didn't work for you?
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What would feeling "well" look like in your daily life? What specific changes would you notice?
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When would you ideally like to see results in your wellness journey?
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Which package are you most interest in learning more about?
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Single Session
5 Pack: The ReRooting
8 Pack: Wellthy Within
12 Pack: Evolve 'U'
How ready do you feel to take the next step in your wellness journey?
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Please Select
I'm ready to begin
I'm curious, but not quite ready
I'm just exploring for now
When are you typically available for coaching sessions?
Weekday (8a-12p)
Weekday (12p-5p)
Weekday (5p-8p)
Weekend (8a-12p)
Weekend (12p-5p)
Any specific availability details you'd like to share?
Claim Your FREE Clarity Consultation Now
Book within 24 hours to receive a complimentary 15-minute consultation, discuss your wellness goals, and explore how we might work together.
One thing I’d like to accomplish most (but haven’t yet) is:
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One thing I wish I could change short term is:
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To me, wellness means:
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I think the most important thing in life is:
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