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Name
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Email 
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What is your main health concern as you age? 
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Tell me about your nutrition and diet.  What do you normally eat at each meal. Do you have any cravings at any point during the day?  
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Are you at your desired weight? If not, how much would you like to lose or gain?
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Do you exercise daily? Is so, what do you do and how often? 
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How is your stress level on a typical day?
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How well do you sleep?  Approximately how many hours per night? 
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Do you know and track your health numbers? If so, do you have concerns about your cholesterol, blood pressure, blood sugar, and/or BMI? 
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How is your memory? Do you currently engage in activities to exercise your brain? If so, please share. 
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What would be your goal or goals if we began working together? 
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Are  you currently taking any supplements?  If so, please share. 
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Anything else you would like to share that might be relevant is welcome.  
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Are you prepared (financially and mentally) to make a change and invest in yourself in a program to help you feel your best?
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Thank you for taking the time to share these details with me!  I will be reaching out soon! Nancy
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