Start - Quick Wellness Form
Email address *
Name *
Your answer
Phone number *
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I drink enough water. I drink ____________ oz every day. *
I am at my goal weight. If yes, post weight, if no, post goal weight. *
Your answer
I eat healthy - Live & Whole Foods with very little processed foods. *
I live a healthy life. I.... check all that apply as true. *
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My greatest source of stress is ________________________.
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I take the following vitamins/supplements daily: *
Your answer
What life's little emergencies do you want to be prepared to solve 24/7? *
Your answer
What health issues do you want to avoid or need targeted support for? *
Your answer
What is preventing you from optimal health? *
Your answer
Imagine where you will be in 5 years if nothing changes. What's keeping you from successfully solving these issues (e.g. lack of desire, tools, education, commitment, personal application, support)? *
Your answer
How would your life change if you could solve these issues? *
Your answer
My main objective of this consultation is
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How important is it to you to be well? *
Your answer
What are willing to give up? do? change? *
Your answer
My current biggest issue is? *
Disclaimer
I understand that Barbara Christensen is not a Doctor or Clinical therapist, nor is licensed to give legal, financial or medical advice. In addition, I agree that I am solely responsible for any action that I take or refrain from taking in connection with the methods used or topics discussed during my session(s) with Barbara Christensen.
I agree *
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