Health Coaching Questionnaire
Health coaching is not intended to diagnose, treat, prevent or cure any disease or condition. It is not intended to substitute for the advice, treatment and/or diagnosis of a qualified licensed professional. Trained health coaches may not make any medical diagnoses, claims and/or substitute for your personal physician's care. As your health coach I do not provide a second opinion or in any way attempt to alter the treatment plans or therapeutic goals/recommendations of your personal physician. It is my role to partner with you to provide ongoing support and accountability as you create an action plan to meet and maintain your health goals.
Email address *
Full Name: *
Your answer
Age:
Your answer
Email Address: *
Your answer
What are your health and wellness goals? (Example: reduce stress, eat healthier, exercise more, etc.) *
Your answer
Describe any diets or fitness programs you are currently participating in. *
Your answer
What would you say is your biggest struggle when it comes to reaching your health and wellness goals? *
Your answer
How soon would you like to set and start working toward your goals? *
Your answer
Would you prefer to work with me in person (if local), by phone, or email/online groups? *
If you selected "by phone", please provide your phone number and the best time to call:
Your answer
Have you been diagnosed or struggle with any health conditions that you are currently working with a physician, are prescribed medication, or are receiving treatment for? *
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