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1. Congratulations on deciding to take control of your health! What is your name?*

2. Why have you made a decision to get healthier and reach out to me for help?*

3. Was there something that prompted you to reach out for help like a milestone or event coming up?*

4. What do you hope to achieve by working with me? How would those results make you feel? Please use as much detail as possible!*

5. What is preventing you from reaching your goals right now?*

6. The value of my coaching program requires an investment in yourself, are you willing to do this to get to your goals?*

Yes
No

7. Is there anyone else in the decision making process who needs to present during our call?*

Yes
No

8. What is your e-mail address?*

9. If you use Facebook/Instagram please leave the link to your page(s) below. Sometimes my first email response goes to spam so I want to make sure I can get a hold of you!*

10. What is the best phone number to contact you?*

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