Health Coaching SurveyΔHealth Coaching Survey We are excited to see you for your upcoming appointment with our Health Coach. Our goal is to be the best wellness and fitness partner for you. Please complete this short survey so we are better prepared for your appointment. Thank you!First NameLast NameEmailWhat do you want to discuss with your Health Coach / what is your goal?What is your daily activity like? How many times do you exercise a week, what type(s) of exercise, and for how long? Please explain if you have any medical conditions (hypertension, blood pressure, diabetes, removed gall bladder, etc.), any allergies/intolerance condition (IBD, celiac disease, acid reflux, crohns, etc.), or special need (down syndrome, autism, cystic fibrosis, cerebral palsy, etc.)? Please provide any details that would be helpful for me to know.What is a health behavior that you do very well and consistently? (i.e., drinking water, walking, stress relief, sleep) What is a health behavior that you do on occasion but would like to do more consistently? (i.e., a couple times a month)What is a health behavior that you don't do but you would like to start working towards?What would you like to see change in your life?Is there anything that you feel like I should know before we start working together?Submit Form
