Are you ready to Feel Your Best?
Are you ready to feel your best? Whether you're looking to boost your energy, improve digestion, balance hormones, or manage weight effectively, this short quiz will help us get to know your health needs. After completing, Judy will reach out to schedule a FREE 20-minute wellness chat and help you start your journey to better health.

Judy offers personalized support through one-on-one coaching, small group coaching, and a monthly Wellness Club. Whichever option suits you, you'll benefit from guidance, accountability, and sustainable habits that promote long-term health and vitality.

Let's get started!
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Email *
Last Name *
First Name *
Who Referred you to Take this Questionnaire?
 *

What stage of life are you in?

*

How would you describe your digestion?

☐ Always bloated

☐ Discomfort after eating

☐ Regular bowel movements

☐ Irregular bowel movements

 *

How well do you sleep?

☐ I wake up rested

☐ I wake up during the night

☐ I get 7-8 hours

☐ I sleep less than 6 hours

 *

On a scale of 1 to 10, how would you rate your daily stress level?

☐ 1

☐ 2

☐ 3

☐ 4

☐ 5

☐ 6

☐ 7

☐ 8

☐ 9

☐ 10

 *

What has been your biggest challenge in staying consistent with your health goals?

☐ Lack of time

☐ Lack of motivation

☐ No accountability

☐ Unclear goals

☐ Other (please describe)

 *
Are you currently taking any supplements? If yes, please list them. 

Which wellness support are you most interested in?

☐ One-on-One Coaching

☐ Small Group Coaching & Private FB Group

☐ I'd love to discuss all options

 *
If you could change one thing about your health, what would it be?
 *

Are you ready to invest (mentally and financially) in your health and start your wellness journey?

☐ Yes, I’m ready!

☐ I have questions but I'm interested.

☐ I'm unsure and a bit nervous.

 *
Anything else you would like to share with me? (health issues, concerns, etc)
 *
Thank you so much for taking the time to share these details with me! I will be in touch!   XO, Judy
A copy of your responses will be emailed to the address you provided.
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