Complimentary Discovery Call
We are so excited to have you here! Welcome to step one in making a powerful transformation in your life. :)
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Email address
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Your email
Untitled Title
Option 1
What is your intention for this call?
Your answer
What is your biggest challenge?
Your answer
Does this challenge affect other areas of your life?
Relationships
Nutrition
Finances/Career
Fitness
Personal Development
Other:
What has blocked you from taking action on this challenge?
Your answer
How ready are you to shift this challenge?
Too scared to take action
1
2
3
4
5
6
7
8
9
10
EXTREMELY ready to move through this
What is the most significant life experience that stands out in your mind? Why is it significant to you and what did you learn?
Your answer
What is your birthday?
MM
/
DD
/
YYYY
Do you have any health conditions? If so, please list below.
Your answer
Do you see any of the following health practitioners?
Acupuncturist
Chiropractor
Hypnotherapist
Naturopath
Nutritionist/Dietitian
Psychiatrist
Reiki Master
Therapist
Traditional Physician
List any medications or supplements you take.
Your answer
What are some typical foods you eat?
Your answer
Do you exercise?
Choose
Yes, everyday.
Yes, 3-5 times a week
Sometimes- between 0-2 times a week
Once in a while
Not often at all
No.
Who do you call for support?
Your answer
Do you have a religious or spiritual practice?
Your answer
How many hours of sleep do you get a night?
Choose
Lucky if I get more than 3 hours.
3-4 hours
5-6 hours
6-7 hours
7-8 hours
9 + hours
How satisfied are you with your career?
Not at all
1
2
3
4
5
Extremely
How satisfied are you with your relationships?
Not at all
1
2
3
4
5
Extremely
How satisfied are you with your health?
Not at all
1
2
3
4
5
Extremely
How satisfied are you with yourself?
Definitely needs works
1
2
3
4
5
I'm the best!
What are you hoping to have by the end of this call?
Your answer
Have you ever had a coach? If so, when, for how long, how much did you invest, and what did you get out of it?
Your answer
Are you willing to invest in yourself to transform your life?
*
Hell Yes!
I might be.
I don't think so.
Send me a copy of my responses.
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