Health & Fitness Assessment
Please fill out the form below by answering each question. The form will take approximately 3 minutes and 27 seconds to complete.
Emerge Health Coaching
Contact Aimee Frazier with any questions:
First & last name
Your answer
Email address (this will be used to contact you with your assessment review)
Your answer
How did you hear about Emerge Health Coaching?
What areas of your physical health would you like to improve? Select all that apply:
What areas of your Mental or Emotional Health would you like to improve? (select all that apply)
How would you rate your current diet?
What is your current level of activity?
What is motivating you to make changes in your current lifestyle?
Your answer
What obstacles might you encounter when working toward your goals? Select all that apply:
Are you ready to begin taking action on your health goals right now?
Do you have any serious health conditions?
If you have a serious health condition, please describe it below:
Your answer
What is your age?
Would you like to be added to the emerge email list and receive occasional emails that contain tools for your health and fitness goals?
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