Let’s Talk!

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First Name

Last Name

Age

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Main Health Goals

Why are you reaching out to a health coach today? What specific health, wellness, and lifestyle changes would you like to make? On a scale of 1-10 how important is it for you to make these desired changes?

How would your life be different if you were to achieve these changes?

What have been your barriers in creating these health changes for yourself?

How do you feel a health coach will help you achieve your goals?

On a scale of 1-10 rate how ready you are to enter a health coaching relationship right now.

On a scale of 1-10 how open-minded are you to learning new ways of eating, moving, and living?

On a scale of 1-10 how willing are you to commit to changes that feel uncomfortable, unusual, or unconventional?

On a scale of 1-10 how willing are you to commit to communicating and negotiating with your health coach as an equal partnership and feel comfortable asking for what you need?

On a scale of 1-10 what is your level of self awareness?

On a scale of 1-10 how well will you keep your word to yourself and your coach?

On a scale of 1-10 do you understand that health coaching is an investment in yourself and you will not suffer about the financial cost.

12 week Living essential Program

Heal your metabolism, get your energy back, and finally lose the weight, FOREVER! Most importantly enjoy food and allow it to heal you!