Body-Mind Goals Assessment
Please provide your first and last name.
Let's begin by assessing your current mind and body state. Check all that apply.
I'm tired/have low energy frequently
I often feel overwhelmed
I am frequently stressed-out
I feel disconnected from my body
I am lacking work/life balance
I feel burned out
I regularly engage in negative self-talk
I am unhappy with my weight
I suffer from anxiety/depression
I regularly do not sleep well
I suffer from inflammation in the body (arthritis, auto-immune disorders, etc)
I am impatient/frustrated frequently
I have poor digestion
Living Inspiration Tribe is about building habits for a better life. What are your desires or goals?
I want to feel reconnected to my body
I want to lose excess weight
I want to have consistent energy
I want less stress in my life
I want to have regular digestion
I want to find balance in my life
I want to eat a healthier diet
I want to take better care of my mind and body
Describe in more detail what health or lifestyle breakthroughs you want to experience. Take a minute - please provide some context or detail.
What is keeping you from experiencing your best self?
My peers don't have the same goals or habits
I need help staying accountable
I don't know where to start to make the changes I would like
I haven't been coached by someone who has reached the goals I want
I try to go it alone and find it difficult to stick to these changes
My family doesn't support a lifestyle change
I haven't invested in the right support
I give up easily when I don't see the progress I think I should
Are you ready to make changes to have the life you want?
Are you ready and able to commit time & financial resources to up-level your habits and identity?
How did you hear about Melinda VanKirk Wellness?
Friends or colleagues
Workshop or Event
Any other details you would like to share?
How would you like to be contacted?
Almost done . . .
After you click "Submit" I will schedule a complimentary call with you to find out more. It's so much fun, and you are going to love it. I will be in touch soon!
A copy of your responses will be emailed to the address you provided.
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