Simple Mapping Exercise
Hello & Thank You for visiting this Simple Mapping Exercise.

This activity offers a combined list of things to check off and items to elaborate on. All of it is optional and intended to provoke your own thinking and potentially help you hone in on things you may want to work on together. Think of it as a running start. There are no right or wrong answers so try not to overthink it.

This activity is not in any way mandatory,  nor does it provide any standardized profiling information. This is a simple template with common discussion items that can help us pinpoint what we might want to work on, also known as trailheads. There is also an open question for any comments or questions you think might better serve your particular needs. This and everything we discuss will remain confidential.

I look forward to the opportunity to help you launch yourself into your vibrant success!

Email *
Phone - *remains confidential*
Best way to be reached-               * no spamming*
Clear selection
Clear selection
I would like to work on:
Clear selection
What is my biggest obstacle?
Clear selection
How happy would I rate myself as being in this moment that I am taking action.
Usually when I set my mind on something...
Clear selection
I consider myself to be an
Clear selection
Choose sentences you most agree with;
Being as healthy as I can be is a priority.
Clear selection
Do you enjoy meditation/mindfulness activities?
Clear selection
What is the activity you most enjoy and get lost in? How often do you do this?
Do you have unused memberships to health facilities/classes/apps?
Clear selection
Do you prefer to exercise with friends, strangers, or solo?
Clear selection
I consider healthy eating a priority.
Clear selection
Think about the last week of meals. Do you typically eat out (count anything you do not cook)
Clear selection
What is your current fitness PRACTICE. How often do you engage in any form of exercise?
Clear selection
My favorite physical activities are:
What are your health goals?
What has been your biggest barrier to self care?
Is weight loss a goal?
Clear selection
When were you most satisfied with yourself / your life?
If I could choose anything and everything to make my life perfect I would pick...
My greatest fear is that...
If I were to become my friend, qualities I would appreciate most would be...
When it comes to self sabotage I usually...
If I could be someone famous I would pick... because...
If I were my parent I would say that the child version of me is...
One thing I regret most in my life is...
The greatest thing I want to change in my life right now is...
I understand this is a coaching service that is not a replacement for therapy or medical treatment. I also understand that although results can be extraordinary and fast, they differ from person to person. If at any time I decide to stop, I can get a refund for unused prepaid sessions. If my coach feels this is not a good match, she will issue a refund for unused prepaid sessions. Please sign full name below.
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy