Client Application
Thank you so much for your interest in working with Dr. Lisette Alba. Please, complete this form as soon as possible. 
 
If you haven't booked a call yet, you can go to CLICK HERE and schedule a free health chat. (Or we can chat via text/Whatsapp at 786-505-8250 or DM me on Instagram @dr.lisettealba).

During our initial call/chat,  we will get to know each other, review the details of the service(s) you have selected, the cost of the programs available and payment options. I cannot wait to guide you on your holistic wellness journey!

If you have already purchased a service, thank you for confiding in me to be your holistic health guide!
  
-💜 Dr. Lisette Alba
Email *
GENERAL INFORMATION
Some basic questions about who you are and how you found Dr. Lisette.
Full Name *
Mailing Address (including zip code) *
Age *
What is your preferred method of contact? *
Phone number *
How did you find Dr. Lisette? *
Are we connected on social media?  *
If you answered "no" above and would like to connect, please share your preferred social media platform below and your handle. Or go follow me @dr.lisettealba on Instagram--this is where I am most active-- and send me a DM.
What service(s) are you interested in? *
Required
SOCIAL
Your current relationships and environment greatly impact your overall health. This will help me understand if we need to address any of these to areas to reach your health goals.
Relationship Status *
Do you have any children? If so, how many? *
Do you have any pets? If so, how many? *
Occupation *
Hours of work per week and typical schedule *
HEALTH + LIFESTYLE
I would like to know some more details about your health and your goals to determine if we are a good fit. Be truthful in your responses, remember I am here to help you on your journey.
Tell me a little bit about you, your biggest health concern or struggle, and where you currently are on your health journey. *
Height and Current Weight (lbs) *
Is your weight a concern?
Clear selection
If yes, what would you like your weight to be?
Please share the primary health concern you are hoping I can help you resolve. *
Are you currently taking any medications or supplements? If so, please list them and tell me why you are taking them. *
List 1-3 health goals you would like to accomplish in the next 3-6 months. *
How is your sleep?  *
Not getting any rest
Wake up fully rested
On average, how many hours do you sleep? *
Do you wake up in the middle of the night? *
If so, what wakes you up?
Are you physically active? Minimum 30 mins of movement/day (active job, walking, gym, yoga, dancing, etc) *
How many days a week do you currently exercise/move your body? *
No days
Every day!
What are your eating habits like? Are you on any special diets? *
Do you cook? *
What percentage of your food is cooked at home? Where does the rest of your food come from? *
Is this an area that you want to change? *
ARE YOU READY TO TRANSFORM YOUR HEALTH?
Why do you think working with Dr. Lisette is right for you? *
Have you worked with a health coach before? If so, tell me a little about your experience. What you did and didn't like? What you wish you had received? *
What made you decide to search for a holistic wellness coach? *
Any healers, helpers, or therapists with which you are involved currently or have seen in the last 12 months? Please list:
Is there anyone involved in making financial decisions with you regarding your health? *
In order to have a successful transformation, you need to commit 3-6 months minimum to accomplish a holistic health transformation (it depends on your individual needs and the service you choose). Are you prepared to invest your time and make the necessary commitment to improve your health? *
If there is anything I have missed or anything you would like to share, please feel free to add it below. *
If you were referred by someone, please include their name here so I can thank them!
Free Guide: HEALTHY HACKS TO REDUCE STRESS
Click above if you would like to receive my FREE GUIDE: Healthy Hacks to Reduce Stress and join my email community.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms