LET’S START
WORKING TOGETHER!

Please share a bit more about what you’re looking for from our work together. This gives me an idea if we would be a good fit. I will be in touch within a few days.

Name

First Name

Last Name

Phone

(###)

###

####

Your Age

City

State

Country

What are your top 3 health challenges?

How would your life be different if your health challenges were resolved in the next year?

What approaches have you tried already that worked for you? Please list.

What approaches have you tried that did NOT work for you? Please list.

What changes do you know you could / should make that you haven’t already made?

What are the biggest barriers to making the changes you already know you should be making?

On a scale of 1 to 10, how committed are you to making the changes you need to make to achieve your health goals?

What is the one change / new behavior you commit to making this week that will move you in the direction of your health goal?

LET’S STARTWORKING TOGETHER!

LET’S START
WORKING TOGETHER!