Discovery Form
Please fill in this form with as much detail as you feel comfortable sharing; this enables me to come into the Discovery Session knowing as much about you and your goals as possible, so your partnership can begin on the right foot.
Email address *
Phone Number: *
Your answer
Preferred method of contact: *
Personal Information
Full Name: *
Your answer
Age: *
Your answer
Main Health Goals
Why are you reaching out to a Health Coach today? What specific health, wellness, and lifestyle changes would you like to make? On a scale of 1-10, how important is to you to make each of these desired changes?

Please list in the level of importance to you.
Desired Health Change #1 *
Your answer
Desired Health Change #2 *
Your answer
Desired Health Change #3
Your answer
Desired Health Change #4
Your answer
Desired Health Change #5
Your answer
How would your life be different if you were to achieve these health changes? *
Your answer
What have been your barriers in creating these health changes for yourself? *
Your answer
How do you feel a Health Coach will help you achieve your goals? *
Your answer
Coachability Self-Assessment
On a scale of 1-10, rate how ready you are to enter a health coaching relationship right now.

1 = I am not ready 5 = I think I’m ready 10 = I am 100% ready and excited!
I am open-minded about learning new ways of eating, moving, and living. *
I am not ready
I am 100% ready and excited!
I can commit to changes that feel uncomfortable, unusual, or unconventional. *
I am not ready
I am 100% ready and excited!
I will communicate and negotiate with my health coach as an equal partnership, and feel confident to ask for what I need. *
I am not ready
I am 100% ready and excited!
I have a high level of self-awareness. *
I am not ready
I am 100% ready and excited!
I will keep my word to my coach and to myself. *
I am not ready
I am 100% ready and excited!
I understand that health coaching is an investment in myself, and I will not suffer about the financial cost. *
I am not ready
I am 100% ready and excited!
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