Kijia: Let's Chat about You!
Fill out the questions below with the most honest information.
Name: *
Your answer
Email Address: *
Your answer
Phone Number *
Your answer
Tell me about you. What habits are you trying to change? Why do you want to change them? How long have you been trying to change them?
Your answer
What are your personal goals? What do you want to be different or easier for you?
Your answer
Why do you think you have honestly failed in the past?
Your answer
If you picture yourself in 6 months, what would you like to have changed? How will making this change make life better for you?
Your answer
Are you the decision maker in attaining these goals?
What is your present level of commitment to address your health and reach these goals that relate to your health, nutrition, fitness and wellness?
not at all ready to change
100% committed to do what it takes
What are some of your favorite things?
Your answer
Can't wait to connect!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy