Wellness Coaching

Pre-screen Questionnaire

Welcome! Thank you for your interest in a unique personalized wellness coaching session. So that we may be better prepared for your comprehensive consultation, please fill out this questionnaire. Once submitted, you’ll be taken to the scheduling calendar to reserve your desired time. We will be in touch, usually within 2 business days, after we receive your questionnaire with any additional information needed for our session.

1. Please complete this basic info about yourself:

First Name

Last Name

Select an Address

Phone

Gender

Age

Referred By

2. What do you personally want to get from this coaching session?

3. What are your biggest strengths?

4. How do you tend to sabotage yourself?

5. What does well-being mean to you?

6. In what way do you find it easiest to learn? What is your learning style?

7. How specifically do you release stress? What do you do to look after yourself on a regular basis?

8. What challenges are you facing in the coming months?

9. Please list anything else you would like me to know in preparation for our session.

If you checked other, please explain:

Thanks for submitting!

Wellness Coaching

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