Discovery Form InstagramThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formDatePlease 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 Δ
