3 Minute Healthy Living Consulting Form
Thank you for taking the time to complete this form. This will give me a good understanding of your wellness & lifestyle desires.  Upon submission, I will contact you via email in 24-48 hours. Thanks! Annie Peguero
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Name *
Phone Number *
Email *
What are your primary health goals? Check all that apply. *
Required
How is your energy and sleep (check all that apply) *
Required
How many servings of fruits and vegetables do you consume on average each day. A serving is the size of your fist. *
Do you experience digestion issues (bloating, constipation or explosive poo)? *
Do you experience joint discomfort? *
Which best describes how you currently feel about your body. *
Which best describes your skin. Check all that apply. *
Required
How would you describe your focus and attention? *
How are you with caffeine? *
Please share about  your alcohol consumption" *
Required
Tell me anything else you're struggling with, working on, or any current health conditions you're experiencing. *
Please provide any wellness products/supplements you currently use. *
Are you interested in solo or group training sessions? *
Please share your assessment of your current wellness and also your desired outcome for working with me to improve your lifestyle. *
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