Free Coaching Call
This form will help me get to know you better and guide our phone call.  At the bottom of this form, you will be able to schedule your free call!
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Email *
Name *
Today's Date *
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Phone Number *
Do you currently live in the U.S.A.? *
How did you hear about Michele Riechman? Did anyone refer you?
How do you rate your overall eating & nutrition habits?
Poor
Awesome!
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Current Level of Exercise
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What is your average level of movement each day?
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Type of exercise that you enjoy or want to try
Do you struggle with sugar cravings?
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Do you struggle with emotional or stress eating?
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What are your major struggles in your health and wellness?
What have you tried that hasn’t worked?
What have you tried in the past that has helped you?
Do you have or want to work towards any goals for your fitness?
Do you have or want to work towards any nutrition goals?
How would you describe your sleep? Check all that apply
On scale of 1-10 rate your current stress level this week.
Very low. I have no stress.
Very high as in I’m experiencing physical manifestations of stress frequently like disabling anxiety or depression.
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What are you looking for in a coach and trainer?
Please add any other information you think that would be helpful. For example, health conditions, injuries, stressors, pregnancy….
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