Health and Wellness Goals Name * First Name Last Name Email * GOALS FOR MY MIND * GOALS FOR MY BODY * When you are feeling overwhelmed and tired, what do you think those feelings are coming from? * I can’t say no when people ask for my help When my stress becomes too much All the above Something else What are your top 3 obstacles when it comes to your health + wellness? How long have you had them? * Are you ready to spend the time, effort and be uncomfortable during your transformation to be a healthier you? * Yes! No Are you open to slowly changing your old habits and behaviors with new sustaining ones to reach your health and wellness goals? * Hell yes! I want to, but I need some support to get there No, I'm not ready to make a change Can you accept that you are in charge of the changes you are looking for when working with me but know I will be there as your guide, support, and cheerleader? * Yes No What have you tried before to try to lose weight, eat right, reduce your stress or put yourself as a priority? * On a scale from (1-10) how committed are you to taking your health and wellness to the next level? * How do you see me helping you reach your health and wellness goals? * How did you hear about me? * Website Facebook Instagram Google Referral Other Anything else you'd like to share? Thank you!
