Intake Form

Please complete the form below to give me more insight into your health history and goals so that I can best tailor our consultation.

Name

First Name

Last Name

Birthdate

YYYY

What brings you here?

Tell me a bit about what you're hoping to work on or improve.

How are you currently feeling — physically, mentally, and emotionally?

Feel free to be honest. There's no right or wrong answer.

What does “feeling your best” look like to you?

This could be about energy, strength, routine, confidence, etc.

What’s your current relationship with food, movement, and rest?

Any habits, challenges, or routines you want to share?

What’s getting in your way right now?

Stress, time, motivation, health conditions — anything that feels like a barrier.

What’s the most important lifestyle shift you think you need to make to support your health?

Have you worked with a coach or health practitioner before?

If so, what worked and what didn't work?

Anything else you'd like to share?