Health Coaching Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please take a few minutes to tell me a little more about what's going on in your health journey!

First Name *

Last Name *

What is your main health/fitness goal?

Lose 30 pounds, build muscle, reduce stress, more energy, etc

What have you tried in the past that worked for you? Or did not work for you?

How much time are you currently devoting to exercise?

30 minutes or more daily

30 minutes or more, 3 times a week

Very little

None

Clear selection

How would you describe your eating habits? Struggles? *

Do you struggle with any of the following? (click all that apply)

Finding time to exercise

Staying motivated to exercise

Getting clear on nutrition that works for you

Overeating in general

Consuming too much sugar

Consuming excess caffeine (more than 200mg/day)

Consuming excess alcohol

Getting at least 7 hours of sleep

Difficulty managing stress/anxiety/overwhelm

Other:

What types of exercise do you enjoy?

Lifting Weights

Cardio

Kickboxing

Yoga/pilates

Boot camp

Dancing

Walking

Running

I struggle here! Don't like any of those

Other:

How much stress do you feel on a typical day?

very little

totally overwhelmed

Clear selection

How well do you cope with the stress you do have to manage?

not well at all

I am feeling confident in stress management

Clear selection

Are you interested in working on your spiritual health along with your physical health?

Yes, that sounds great

Not right now

Not sure - I'd love to find out more

Clear selection

Do you have any injuries or health concerns that affect your nutrition and exercise needs?

What is your email address? *

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.