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* 1. Please enter your name, email address, and phone number.

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* 2. Tell me a little bit about you (you can include profession, family, health habits, etc).

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* 3. What are you currently doing well in your wellness journey?

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* 4. What do your current eating habits look like?

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* 5. What do your current exercise habits look like?

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* 6. Why are you interested in doing One-On-One Coaching now?

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* 7. If you had a magic wand and fast-forwarded 4 months, and everything was exactly like you're imagining, what would that look like?

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* 8. What is preventing you from reaching your goal(s) right now?

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* 9. What have you already tried (that worked or did not work)?

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* 10. On a scale of 1-10 (1 being low, 10 being high), how motivated are you to change how you look and feel for good?

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i We adjusted the number you entered based on the slider’s scale.

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