Free Health Consultation
Please complete this form so I can better understand your health goals and learn more about your health history.
(6 years experience leading online Health and Fitness Accountability groups)
1.) Current Weight
3.) Goal Weight
What results do you desire?
Weight and/or Health and Why?
What has worked for you in the past?
Why and what did you like or dislike about these techniques?
Tell Me How Challenging Each Issue Below is for You.
Time Management is Challenging for Me
Motivation is Challenging for Me
Finances are Challenging for Me
Support is Challenging for Me to Find
Knowledge is Challenging for Me to Obtain
All of the above
None of the above
What family history concerns you?
High Blood Pressure
Why is this a priority to you NOW?
What made you decide to reach out?
What is the Best way to contact you from the contacts listed above?
Do Not Fill This Out