Health and Well-Being Strategy Call Questionnaire
Please answer these questions prior to scheduling your call! I will use them to guide our discussion and to make the best use of our time. When you submit the questionnaire, you'll be taken to a page with the scheduling link.

Thank you! I look forward to talking with you!

Email address *
What is your full name? *
Your answer
What is your phone number? (So that I can call you for our call). *
Your answer
How would you rate your health on a scale of one to ten? *
Tell me about your biggest challenge right now and where you would like to have help in reaching your goals. *
Your answer
Is there anything else that’s a big struggle or roadblock for you? *
Your answer
Are you under the care of a doctor right now for any medical condition or taking any prescription medications? *
Your answer
What are the top 2 or 3 things you would like help with? *
Your answer
Why are they important to you? *
Your answer
What's the most important thing you think you should do to improve your health that you aren't doing right now? *
Your answer
How would your life be different if you could overcome your health challenges in the next six months to a year? *
Your answer
Is there anything else you want to share?
Your answer
A copy of your responses will be emailed to the address you provided.
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