Pre-Consult
Please take your time and dig deeply to answer these questions. Protect your privacy as desired by using any email address you wish. This form is for consultation purposes only for health coaching (not Medical services provided as a RD).
Sign in to Google to save your progress. Learn more
Email *
Your name: *
What goals are you hoping to accomplish in the next 6-9 months? Why is that important to you? *
What is it you expect to BE different in your life when you reach that goal? *
How do you expect to FEEL differently when you reach that goal? *
What do you feel has been holding you back from achieving this outcome successfully up until now? *
What have you tried in the past to achieve these outcomes that felt good or that you felt worked well? *
Are there any other obstacles you anticipate may prevent you from being successful while we work together? *
When do you currently feel the best about yourself and your nutrition? Please describe these moments emotionally and visually. *
When do you feel the most triggered by food or disempowered in your mind and your body? Please describe these moments emotionally and visually. *
How do you normally react (in the actions you take and/or emotionally/mentally)when you feel this way? *
Do you have previous experience working with a coach? If so, what did you enjoy about that experience and what did you dislike about it? *
What role do you hope for me to play in your journey if we decide to work together? *
Sign me up for regular messages from Julie Wallace and her team regarding (select all): *
Required
I understand Julie will reach out to me within 48 business hours to discuss our next steps using the email address provided above. If I do not see an email, I will check my spam folder and reach out through email/contact form. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms