Discovery Questionnaire

Perfect! I look forward to our call.

If you’d like, you can answer the questions below to help me prepare for our Discovery Session.

Which wellness need(s) are you seeking help for right now? (Can select multiple answers)

Specific medical challenge (diabetes, cholesterol, joint pain, headaches, thyroid, or other ___________________)

Lifestyle improvement to improve overall health and anti-aging

Anxiety/depression from life, COVID, relationships

Physical feelings of low energy

Weight loss or other dietary enhancements

Meditation/spiritual/energy practice improvement

On a scale of 1-5 (low-high) how important is it to you to improve your health and achieve your health goals?

1 - Very Low

2 - Low

3 - Neutral

4 - Important

5 - Extremely Important

And WHY IS IT IMPORTANT to you that you improve your health and achieve your health goals?

What kinds of treatments or methodologies do your currently use for your health and wellness? (check all that apply)

Nothing much

Western Medicine

Eastern Medicine

Regular Meditation

Yoga

Regular Exercise

Vegetarian or Vegan

Gluten Free

Vitamins & Supplements

How much are you currently spending and/or investing in your health and wellness (prescriptions, coaches, medical care, alternative health practitioners)?

Less than $1,000 per year

$1,000-$2,500 per year

$2,500-$5,000 per year

More than $5,000 per year

A few more general details and we'll be all set for your Discovery Session!

First Name

Last Name

What do you do for work?

What is your age range?

19 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 - 84

85 - 94

95+

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Discovery Questionnaire

A few more general details and we'll be all set for your Discovery Session!

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