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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