All of your information will remain confidential between you and the Health Coach.
Would you like your weight to be different?:
Please list your main health concerns:
Do you take any supplements or medications? Please list:
Any healers, helpers or therapies with which you are involved? Please list:
What role do sports and exercise play in your life?:
What foods did you eat often as a child?
Will family and/or friends be supportive of your desire to make food and/or lifestyle changes?:
Do you crave sugar, coffee, cigarettes, or have any major addictions?:
The most important thing I should do to improve my health is:
What is your food like these days?
Anything else you would like to share?: