Coaching Client Questionnaire
Thanks so much for your interest in working with me for one-on-one health coaching.  Please watch the video below and find out what 1:1 health coaching with me looks like and why I'll be a good fit for you.
Sign in to Google to save your progress. Learn more
One-on-one coaching is a commitment for both of us.  That's why I think it's important to make sure that we're a good fit for each other. Please fill out the questionnaire and be sure to book your FREE 15-minute discovery call at the end.
Name *
Email *
Phone Number *
Social media handle or name
Timezone *
What prompted you to reach out to me or click on my post or ad? *
What are your primary health and wellness goals? *
What are your primary challenges to achieving those goals? *
If not already mentioned, do you have any diagnosed medical conditions? If so, please list them here. 
On a scale of 1 to 10, how committed are you to making changes with your health and wellness?
 *
When it comes to nutrition, are you looking for a completely structured meal plan with grocery lists, a general idea of what to eat, or a combination of both? 
 *
At this time, are you willing to make an investment in your nutrition goals and a coaching program?
 *
Do you have any reservations about joining a health coaching program? If so, please list them here!
 *
Is there anyone else involved in the decision-making process that needs to be involved on our chat through Zoom?
 *
If we decide we are a good fit to work together during our Zoom chat, will you be ready to start in the next 30-60 days?
 *
How did you hear about Peppermint Tea Holistic Health & Wellness or Robyn Mooring? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms