Health Goals Conversation

Thank you for taking the first step to tune into your body for elevated health and happiness. Please complete this form before your scheduled conversation.

During our time together, you’ll lead the conversation. I want to hear your health story and help you write the next chapter. We will discuss your goals and how we can get there, together.

All information will be kept confidential between you and your health coach.

Name

First Name

Last Name

Phone

(###)

###

####

Age

Relationship Status

Occupation

HEALTH

What are your primary health goals?

Any other concerns or goals?

What is your timeframe for making changes to your health?

I'm already working on it!

Within the next month

3-6 months from now

Within the next year

I'm not sure

At what point in your life did you feel your best?

How is your sleep?

Any allergies or sensitivities?

Will your family and friends be supportive of your desire to make food and/or lifestyle changes?

Yes

Maybe

What is the most important thing you should change about your diet/lifestyle to improve your health?

Is there anything else you would like to share?