top of page
Home
About
Shop
Gift Card
4-Day Cleanse LIVE
Book Additional Coaching Sessions
30-Day New You Program
4-Day Cleanse DIY
Nourished to Alive
Recipe Club
Refer Friends
Blog
Podcast
More
Use tab to navigate through the menu items.
Client Love
Contact
Booking
Apply To Work With Me
Members
Members Booking
Members Only Recipes
More
Use tab to navigate through the menu items.
Schedule Your Free Session
Click Here to Join the LIVE round of the 4-Day Nourishment Cleanse starting January 6th!
First Name
Last Name
Email
Select a date
What positive changes in your health and well-being have you noticed since starting the program?
What goals have been met? What are you proud of the most, your biggest wins?
Reflecting on your progress – how would you rate your level of commitment to your health, during the program? Rate yourself 1-5, where 5 indicates the highest level of progress. Remember, commitment equals progress.
If you did not rate your commitment a 5, how can you re-frame to make it a 5? Remember, everything happens FOR you, not TO you.
Would you recomend working with a personal health and nutrition coach to a friend or loved one? Why?
Please list any people in your life you think could also benefit from working with a personal health and nutrition coach.
Any other reflections, you'd like to share?
Any changes with weight? Weight-loss, Weight-gain, Weight is Stable
How is your sleep? Better, Worse, Improved, Excellent
How is your Digestion, Constipation or Diarrhea? Better, Worse, Improved, Excellent
How is your mood? Better, Worse, Improved, Excellent
Are you exercising? More, Less, or Regular
What are you looking forward to the most in the next chapter of your wellbeing journey? What type of continued support do you need to keep this momentum going?
Any other comments?
I CONSENT:In my Intake Forms and assessment forms, I ask for some limited health history from you. I ask these questions because health coaching guidance can be more useful if I know the overall context. In addition, I may want to encourage and advise you to consult with your medical professionals for any disease conditions. I may refer you to various networks of healthcare professionals, and therefore it will be easier if I have a more complete record of your overall wellness. I am only providing coaching guidance— focusing on lifestyle, habits, and goals—and never giving you medical or psychological advice about the underlying condition.
Submit
CONGRATS on your Commitment to your HEALTH, the greatest WEALTH
bottom of page
