Discovery Form Please complete the following form with as much detail as you are comfortable sharing. This will enable me to better understand your current health goals in advance of our Discovery Call so I can properly prepare. Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastEmail *PhoneAge *Main Health GoalsWhy are you reaching out to a health coach? What specific health, wellness, and lifestyle changes would you like to make? Please rate each of your goals on a scale of 1-10, how important is each of these desired changes that you would like to make?Must fill in at least one Health Goal. 1 = not very important, 10 = non-negotiable.Health Goal *Rating *12345678910Health Goal 2Rating 212345678910Health Goal 3Rating 312345678910Health Goal 4Rating 41 2345678910Health Goal 5Rating 512345678910Health Goal 6Rating 612345678910How would life be different if you were to achieve your health goals? *What have been the barriers in preventing you from already achieving these goals yourself? *How do you feel a Health Coach will help you achieve your goals? *Coachability Self-AssessmentOne a scale of 1-10, rate how ready you are to begin a health coaching relationship right now. 1 = Not ready at all, 5 = I think I’m ready, 10 = I am 100% ready and excited! I am open to learning new ways to eat, move and generally live. * 12345678910 1I am open to learning new ways to eat, move and generally live. 12I am open to learning new ways to eat, move and generally live. 23I am open to learning new ways to eat, move and generally live. 34I am open to learning new ways to eat, move and generally live. 45I am open to learning new ways to eat, move and generally live. 56I am open to learning new ways to eat, move and generally live. 67I am open to learning new ways to eat, move and generally live. 78I am open to learning new ways to eat, move and generally live. 89I am open to learning new ways to eat, move and generally live. 910I am open to learning new ways to eat, move and generally live. 10 I can commit to changes that may feel uncomfortable, unusual or unconventional. * 12345678910 1I am open to learning new ways to eat, move and generally live. 12I am open to learning new ways to eat, move and generally live. 23I am open to learning new ways to eat, move and generally live. 34I am open to learning new ways to eat, move and generally live. 45I am open to learning new ways to eat, move and generally live. 56I am open to learning new ways to eat, move and generally live. 67I am open to learning new ways to eat, move and generally live. 78I am open to learning new ways to eat, move and generally live. 89I am open to learning new ways to eat, move and generally live. 910I am open to learning new ways to eat, move and generally live. 10 I will communicate and negotiate with my coach as an equal partnership and feel confident to express myself and ask for what I need. * 12345678910 1I am open to learning new ways to eat, move and generally live. 12I am open to learning new ways to eat, move and generally live. 23I am open to learning new ways to eat, move and generally live. 34I am open to learning new ways to eat, move and generally live. 45I am open to learning new ways to eat, move and generally live. 56I am open to learning new ways to eat, move and generally live. 67I am open to learning new ways to eat, move and generally live. 78I am open to learning new ways to eat, move and generally live. 89I am open to learning new ways to eat, move and generally live. 910I am open to learning new ways to eat, move and generally live. 10 I have a high level of self awareness. * 12345678910 1I am open to learning new ways to eat, move and generally live. 12I am open to learning new ways to eat, move and generally live. 23I am open to learning new ways to eat, move and generally live. 34I am open to learning new ways to eat, move and generally live. 45I am open to learning new ways to eat, move and generally live. 56I am open to learning new ways to eat, move and generally live. 67I am open to learning new ways to eat, move and generally live. 78I am open to learning new ways to eat, move and generally live. 89I am open to learning new ways to eat, move and generally live. 910I am open to learning new ways to eat, move and generally live. 10 I will keep my word to my coach and myself. * 12345678910 1I am open to learning new ways to eat, move and generally live. 12I am open to learning new ways to eat, move and generally live. 23I am open to learning new ways to eat, move and generally live. 34I am open to learning new ways to eat, move and generally live. 45I am open to learning new ways to eat, move and generally live. 56I am open to learning new ways to eat, move and generally live. 67I am open to learning new ways to eat, move and generally live. 78I am open to learning new ways to eat, move and generally live. 89I am open to learning new ways to eat, move and generally live. 910I am open to learning new ways to eat, move and generally live. 10 I understand that a health coach is an investment in myself and will not suffer with the finical costs. * 12345678910 1I am open to learning new ways to eat, move and generally live. 12I am open to learning new ways to eat, move and generally live. 23I am open to learning new ways to eat, move and generally live. 34I am open to learning new ways to eat, move and generally live. 45I am open to learning new ways to eat, move and generally live. 56I am open to learning new ways to eat, move and generally live. 67I am open to learning new ways to eat, move and generally live. 78I am open to learning new ways to eat, move and generally live. 89I am open to learning new ways to eat, move and generally live. 910I am open to learning new ways to eat, move and generally live. 10 Submit