This questionnaire will allow you to reflect on your current health situation and help you decide how you want to master your health and wellness. It's a key step in your success!

Please complete the questionnaire at least one day before your first session.
All your information will remain confidential.

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* 1. Basic Information

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* 2. Mark which areas of wellness you want to work on. For the areas you choose yes, indicate the priority level, and your level of confidence in achieving the goal.

  Work on this? Priority Level (1 = high priority, 2 = medium priority, 3 = low priority) Confidence Level (1 = very confident, 2 = fairly confident, 3 = not confident)
Improve life satisfaction
Increase Energy
Improve physical activity
Improve eating habits
Decrease Stress
Weight Management
Improve one or more health conditions

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* 3. What is the first area you would like to work on?

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* 4. How will friends and family support you?

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* 5. How would you describe your ideal personal coach?

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