Intake Form

This should only take a few minutes. Promise! Simply indicate how strongly you agree with each statement below. This will help me understand how to give you the most benefit from our coaching sessions. Thanks!

"I feel healthy and am in good physical condition."

"I'm very happy with my diet"

"I get 7 to 8 hours of sleep per night and wake up rested"?

"I have typical stresses and can manage them well"

"When I look in the mirror I feel grateful with the body I have"

"I'm good at taking time out for myself"

"I don't get addicted to substances and drink in moderation"

"I don't suffer any physical pain and I rarely get injured"

"I feel positive about my life and have energy throughout the day"

"I am aware of my thoughts and I can control my actions"

"I enjoy learning and self-growth is important to me"

"I have a great family/friends I can always turn to for support"

"I am happy in my work and find it rewarding"

"I laugh, have fun and 'play' everday"