Wellness Glow Up SessionQuestionnaire Name * First Name Last Name Email * Phone (###) ### #### What are your top 2-3 wellness goals you would like help with? Why are these important to you? * What are your biggest health/wellness struggles, challenges and obstacles right now? * What have you tried in the past? What has been effective for you? * Where would you like your health to be 6 months from now? * How would it feel to reach these goals? How would it affect your life? * What is your current diet like? Please be specific, list typical breakfast, lunch, dinner and snacks. List any known allergies or food sensitivities. * Describe your current activity level. Are you doing any kind of daily movement practice? What do you LIKE to do for movement? What do you DISLIKE? * Are you taking any medications or supplements? Please list what you take and what it's for. * Are you working with a doctor or alternative health care provider? * Yes No Name of above provider: What are 2-3 things that you know you could be doing for your health that you are not currently doing? * What are 5 things you love about your life? * What do you hope to gain from our time together? * Is there anything else you'd like to share with me? * Thank you!
