Discovery Form Please fill in this form with as much detail as you feel comfortable sharing; this enables me to come into the Discovery Session knowing as much about you and your goals as possible, so our partnership can begin smoothly and easily. Personal Information Name * Email * Age Phone Number Main Health Goals Why are you reaching out to me today? What specific health, wellness, and lifestyle changes would you like to make? Desired Health Changes How would your life be different if you were to achieve these health changes? What have been your barriers in creating these health changes for yourself? How do you feel I will help you achieve your goals? Coachability Self-Assessment On a scale of 1-10, rate how ready you are to enter a health coaching relationship right now. 1 = I am not ready 5 = I think I’m ready 10 = I am 100% ready and excited! I am open-minded about learning new ways of eating, moving, and living. Select 1 2 3 4 5 6 7 8 9 10 I can commit to changes that feel uncomfortable, unusual, or unconventional. Select 1 2 3 4 5 6 7 8 9 10 I will communicate and negotiate with my health coach as an equal partnership, and feel confident to ask for what I need. Select 1 2 3 4 5 6 7 8 9 10 I have a high level of self-awareness. Select 1 2 3 4 5 6 7 8 9 10 I will keep my word to my coach and to myself. Select 1 2 3 4 5 6 7 8 9 10 I understand that health coaching is an investment in myself, and I will not suffer about the financial cost. Select 1 2 3 4 5 6 7 8 9 10 If you are human, leave this field blank. Submit