Name
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First Name
Last Name
Email
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Phone
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Age
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What is your prefered method of Communication?
1. Do you have any existing medical conditions or diagnoses? (e.g., diabetes, heart disease, asthma)
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2. Are you currently taking any medications or supplements? If yes, please list them.
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3. Have you had any major surgeries or hospitalizations in the past? If yes, please describe.
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4. Do you have any allergies or intolerances? If yes, please specify.
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5. Do you have any dietary restrictions or preferences? (e.g., Vegan, Gluten-Free, Low Sodium)
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6. How many hours of sleep do you get on average per night?
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7. Do you have any current exercise or physical activity routine? If yes, please describe.
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8. What is your current level of physical activity? (e.g., Sedentary, Lightly Active, Moderately Active, Very Active)
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9. How would you describe your current diet? (e.g., Balanced, High in Carbs, Low in Protein, Vegetarian, etc.)
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10. What are your primary health and wellness goals? (e.g., Weight loss, Improved fitness, Stress reduction, Better sleep)
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11. What specific outcomes are you hoping to achieve through coaching? (e.g., Running a 5K, Reducing cholesterol, Developing a consistent workout routine)
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12. Have you previously worked with a health or wellness coach? If yes, what was your experience?
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13. What motivates you to pursue health and wellness coaching?
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14. What challenges or obstacles have you faced in achieving your health and wellness goals?
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15. How do you typically handle setbacks or difficulties in your wellness journey?
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16. How frequently would you like to have coaching sessions? (e.g., Weekly, Bi-weekly, Monthly)
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17. What do you hope to gain from our coaching relationship?
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18. Is there any other information you believe is important for me to know in order to support you effectively?
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19. Do you have any questions or concerns about the coaching process?
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