Health & Wellness Questionnaire

Please fill out only what you are comfortable sharing with me. Only I will see your results. I will not share or sell your infortmation.

First name

Last name

Email - Don't worry I won't send you spam emails!

What town/city do you currently live in?

Please answer the first 4 questions using a scale of 1-10. 1 being the lowest and 10 being the highest.

1. How would you rate your overall health & wellness?

2. How much do you care about your health & wellness?

3. What is your average daily energy level?

4. What is your average daily stress level?

5. How old are you?

6. What is your occupation?

7. What is your biggest barrier to maintaining a healthier lifestyle?

8. What kind of resources or programs would benefit you in a health & wellness journey?

9. How much money would you spend on bettering your health & wellness?

10. Would you ever consider hiring a health & wellness coach?

11. If you answered YES to question 10 please share some goals or objectives you would work towards during a health & wellness journey.

Thank you so much for your time. If you ever decide health & wellness coaching is for you, I will give you 40% your first 90 days working with me.