Discovery Form HiddenDate Please fill in this form with as much detail as you feel comfortable sharing; this enables your coach to come into the Discovery Session knowing as much about you and your goals as possible, so your partnership can begin on the right foot. I request that you complete the form at least 1 full business day in advance of your appointment. At the bottom of the form there is an option to ‘Save and Return Later’ for your convenience.Personal InformationName* First Last Age* Email* Enter Email Confirm Email Phone*Main Health GoalsWhy are you reaching out to a Health Coach today? What specific health, wellness, and lifestyle changes would you like to make? On a scale of 1-10, how important is to you to make each of these desired changes?Desired Health ChangesAdd your Desired Health Changes below*Importance (1 – 10)*1 = not very important10 = non-negotiablePlease enter a number from 1 to 10.Add your Desired Health Changes belowImportance (1 – 10)Please enter a number from 1 to 10.Add your Desired Health Changes belowImportance (1 – 10)Please enter a number from 1 to 10.Add your Desired Health Changes belowImportance (1 – 10)Please enter a number from 1 to 10.Add your Desired Health Changes belowImportance (1 – 10)Please enter a number from 1 to 10.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 a Health Coach will help you achieve your goals?Coachability Self-AssessmentOn a scale of 1-10, rate how ready you are to enter a health coaching relationship right now. 1 = I am not ready5 = I think I’m ready10 = I am 100% ready and excited!I am open-minded about learning new ways of eating, moving, and living. 1 2 3 4 5 6 7 8 9 10 I can commit to changes that feel uncomfortable, unusual, or unconventional. 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. 1 2 3 4 5 6 7 8 9 10 I have a high level of self-awareness. 1 2 3 4 5 6 7 8 9 10 I will keep my word to my coach and to myself. 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. 1 2 3 4 5 6 7 8 9 10 NameThis field is for validation purposes and should be left unchanged. Δ
