How often do you check your emails
Best time to contact
Place of birth
What do you hope to get out of our coaching series?
What areas of you health and wellness are you felling really good about right now?
What areas are challenging you right now?
What is the number one thing you could do for your health right now?
How do you take care of yourself?
How does your inner voice hold you back? Take some time on this one.
Is there anything you want to tell me ? Is there an area of your life you don’t want me to ask about but also really do want to talk about it.
Relationship status (required)
Were do you currently live
Hours of work
Weight six months ago
Weight One year ago
Would you like your weight to be different?
If so what?
Please list your main health concerns
What are your main health goals?
At what point in your life did you feel best ?
Any serious illness/hospitilisations/injuries?
How is/ was the health of your mother?
How is/ was the health of you Father?
Do you sleep well?
How many hours do you sleep?
Do you wake up at night?
If so why?
Any pain stiffness or swelling in your body?
Do you regularly get Constipation/diarrhea/gas?
Allergies or sensitivities? Please explain
Do you take any supplements or medications? Please list
Are you currently undergoing any Healers, helpers, or therapies?
What role does sports and exercise play in your life?
What do you normally eat for the following, please list a few examples :
Liquid including alcohol
Have you ever counted calories to control your weight?
Have you ever done a fad diet?
Do you ever skip meals to control your weight?
Do you ever eat to control your emotions?
Do you crave sugar, coffee, cigarettes or have any major addictions?
Do you cook?
What percentage of your food is home cooked?
Where do you get the rest from?
Will your friends and family be supportive of your desire to make food and life style changes?
The most important thing I could do to change my diet is?