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discovery form

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  • 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 Information

  • Main Health Goals

  • Why 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 Changes

  • 1 = not very important
    10 = non-negotiable
    Please enter a number from 1 to 10.
  • Please enter a number from 1 to 10.
  • Please enter a number from 1 to 10.
  • Please enter a number from 1 to 10.
  • Please enter a number from 1 to 10.

  • 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!
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later

Questions?

contact coach ken
contact coach ken

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