One-on-One Coaching Request
SKYPE Name or Phone Number
Please fill out this form to the best of your ability (write as much as you desire!)
How would you describe the state of your current health now?
What is it you are wanting to achieve in the next 3 months?
What are 2-3 areas affected by not having your ideal health?
Why do you want to change your current state of health?
What does your optimal health look like?
How will you feel? What will you do?
What has been your biggest challenge?
What has worked for you in the past? Why do you think it worked?
What hasn’t worked for you in the past? Why do you think it didn’t work?
What do you typically eat throughout the day? Include breakfast, lunch, dinner, snacks, and drinks.
What foods would you like to eat LESS of? Why?
How much water do you drink per day?
List any physical activity
Frequency and duration
Now, let’s get to the nitty gritty. Tell me about your digestion.
How often do you have bowel movements? Are they pleasant? Do you experience any bloating/gas? The more you share, the better.
What motivates you?
What demotivates you?
List your main concerns or goals which have prompted you to seek out health coaching.
What do you need the most help with right now?
How to Cook
Serious Health Condition
Digestive issues (IBS, Constipation)
How did you find out about my program?
Please list any other additional information you would like for me to know :)
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