Name: *

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Can you briefly describe a typical day in your life?: *

How happy arey ou with your overall lifestyle? (1=miserable 10=thriving): *

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What is your biggest struggle right now when it comes to your health and happiness?: *

What have you already tried to improve this?: *

What’s been the most frustrating part about trying to make a change?: *

Which of these challenges feel most true for you?: *

I struggle with consistencyI don’t know what actually works for meI’ve tried so many things and nothing sticksI’m overwhelmed with all the information out thereI fall into an all-or-nothing mindsetI start strong but lose motivationI feel like I don’t have enough time for myselfOther

What would achieving your ideal health and happiness look like?: *

If nothing changes, how do you think you’ll feel in 6 months?: *

How much longer are you willing to stay stuck in this cycle? (1=I can't do this anymore 10= I'll figure it out on my own): *

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How committed are you to making a real change? (1=I just want to learn more 10=I’m ready to do whatever it takes): *

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What kind of support do you think you need?: *

A clear sustainable plan that actually worksAccountability and guidance from someone who gets itA supportive community to keep me motivatedA deep mindset shift so I stop self-sabotaging

If you had the right plan and support, what do you think would be possible for you?: *

How urgently would you like me to reach out personally to discuss how I can help? (1=Maybe, I need more info 10 =Yes, let’s chat!): *

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Is there anything else you want me to know before we talk?: *

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