2025 Jotform Client Assessment

TRANSFORMATION BEGINS HERE

LIVE LONGER. MOVE BETTER. FEEL UNSTOPPABLE
Full Name

First Last
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Instagram
What are your Wellness Goals? (check all that apply)
How many glasses/bottles of water do you drink a day? (On average)

1

2

3

4

5

6

7

8

1 is One daily, 8 is I love water!
Have you tried any Transformational wellness programs before?
If yes, what did you try and what were the results?
What challenges have kept you from getting results in the past? (what applies)
Any dietary preferences or restrictions
Very important, to create custom plan
Typical day of eating? (Please add cost of each meal $$)
If no put NA
When would you like to see a meaningful change?
What's your current monthly wellness budget
On a scale of 1 to 10, how committed are you to achieving your wellness goals?

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2

3

4

5

6

7

8

9

10

1 is Lowest, 10 is Extremely
Preferred accountability style?
Do you want me to let you slack, or NOT accept any excuses and be on you tough?
Agreement & Next Steps
Best time to contact you?
Please give couple time slot options
After helping thousands of people transfrom their lives, there's one thing I've learned--that you are unique. Your journey is like no one else's, so let's create a plan just for you. -Style Bell
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TRANSFORMATION BEGINS HERE