Live Eat Breathe Initial Intake Form
Description
Email address *
What is your biggest reason for reaching out today? *
Your answer
Why do you feel we would be a good fit? *
Your answer
What area of your life do you feel you need the most help with? Why? *
Your answer
Tell me a bit about yourself: *
Your answer
Do you have any physical health concerns? If yes, please describe. *
Your answer
Do you have any mental health concerns? If yes, please describe. *
Your answer
Do you consider yourself spiritual? If not, is spirituality something you are curious about? Please expand. *
Your answer
How would you describe the way you feel when you wake up? (i.e. Inspired? Grateful? Depressed? Irritable? High energy? Low energy? etc.) *
Your answer
Where do you see yourself in 5 years? *
Your answer
If nothing was holding you back, what would you want your life to look like? Think BIG. *
Your answer
What do you feel is currently stopping you from creating the life you truly want? *
Your answer
Are you working with an abundance mindset or a scarcity mindset? (Be honest!) *
Fixed mindset or growth mindset? (Be honest!) *
What sets your heart on fire? Tell me what inspires you! *
Your answer
What is the best way to get in touch with you? *
Please include any additional contact information I may require so we can book our 30 minute consultation:
Your answer
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