520-329-7085
bridget@healthylivingwithbridget.com
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Health Coaching Consent Form
Client Info Form
Name
Home Phone
Cell phone
Email Address
Occupation
Education
How did you hear about me?
― HISTORY
Describe greatest accomplishments to date:
What made these accomplishments stand out for you?
What have you incorporated into your current actions from your past accomplishments?
― YOUR LIFE
Who are or have been your major role models?
What attributes of these role models do you admire and want to emulate?
What are the 5 most positive things in your life?
― YOUR SELF TODAY
List 5 adjectives that describe you at your best.
What prevents you from being at your best?
What energizes you?
What saps your energy?
What do you consume now, that if you didn’t, would allow you to be healthier
― YOUR POTENTIAL
What are you most wanting to achieve in next 6 months with nutrition and wellness?
How ready are you for it?
― MAKING IT HAPPEN
Why have you considered a health and wellness coach?
How can I help you be more effective in working towards your goal?
What approaches have you found less effective for you?
Submit
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