LVL Holistics
Cooking Classes!


All of my cooking classes are personalized! Please feel out the form as best as you can and I'll email you to schedule a consultation.

Name
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Age
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Date of Birth
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Phone Number
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Email
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How did you hear about LVL Holistics?
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Relationship Status
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Kids? Pets?
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Occupation
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Please list main health concerns
No need to be shy here, trust me I have heard it all!
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If you could wave a magic wand, and achieve any goals in 3 months, what would they be?
Think as big as you want here
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At what point in your life did you feel best?
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Any serious illnesses/hospitalizations/injuries?
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Do you sleep well? How many hours?
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Do you have any allergies(food or otherwise)?
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List any supplements or medications you take
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What confuses you most about nutrition? Please be specific as possible.
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How can I best support you?
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Will friends/family be supportive of your desire to make food and/or lifestyle changes?
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The most important thing I could do to improve my health is....
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1-10 how secure do you feel financially-1 being the least 10 being the most? (Coaching is an emotional and financial investment in yourself) * *
How motivated are you to make changes?
List three days and times that work best for your session
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Anything else you'd like to share?
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