Client Application | Vitality Holistic Health & Wellness

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Vitality Roadmap Session Questionnaire

Tell me about yourself...

First name*

Last name*

Email*

Phone

Birthday*

Month

Day

Year

Gender *

Male

Female

Other

What brings you to Vitality?*

What are your primary health concerns, challenges, and goals? *

Have you been diagnosed with ANY conditions (mental, physical, etc)? Even something as small as headaches or high blood pressure is relevant here. List concerns from greatest to least importance, please.*

What have you tried already? What has worked? What has not worked?*

Have you ever worked with a nutritionist, health coach, or personal trainer before? If so, what services did you receive? What were you happy with? What did you dislike? What are you hoping to gain from a coaching relationship?*

If you could envision yourself living with the most vitality you could, what would that look like?*

On a scale of one to ten, how ready, willing, and able are you to invest in your physical, mental, and emotional well-being?*

Embarking on your journey to true whole body healing requires both an investment in time and finances and offers a massive, life changing payoff. Without investing in yourself and your health, you likely wont get the results that you're looking for. *

I am 100% willing to invest in myself

I want to be committed to myself, but I have some questions first

I am not willing to invest in myself

Will you be making this decision on your own, or will there be another decision-maker involved that will have a large or final say in your decision?*

Nope. I am ready and able to make a decision either way on my own

Yes. I have someone else that will be involved in making the final decision and I will do my best to have them on our call

Would you prefer a zoom call or for me to call you on the phone. Please note, a zoom link is generated automatically. *

Telephone is best. Please save 412-254-4620 to your contacts.

Zoom is great. Awesome, you will get the link sent to you after submission.

Are you excited to change the course of your life and regain your health!?

Let's do this!

Ten times over, yes!

Courtney@VitalityHolisticHW.com

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