Health Goals Strategy Questionnaire

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Please fill out this form according to your comfort level. This will help me prepare for our call so that our time can be used effectively.

*Disclaimer: I am an educator sharing what I've learned about health, wellness, being your own advocate, and goal setting. I can help you with questions you might want to ask your doctor and with researching information pertaining to your health. I am not a medical professional and cannot give medical advice.

Email *

Name *

What is your greatest concern about your health right now and how are you currently feeling?

Have you received a particular diagnosis that is causing issues for you? If so, would you mind sharing the diagnosis?

Do you feel that your doctor really listens to your concerns and addresses them effectively?

Yes

Maybe

Clear selection

Which categories of your health are you wanting to tackle the most?

Stress

Sleep

Exercise/movement

Food/diet/meal planning

Setting healthy boundaries

Self-care

Questions for your doctor

Other:

Which one of the choices above would you say is the biggest priority for you? (It's okay if you don't know the answer to this yet. Just leave it blank if you're not sure.)

Do you use a calendar or planner?

Yes, digital

Yes, paper

Yes, both digital and paper

No, but I'd like help with that.

No. I don't use a calendar or planner, and it seems to work well for me.

Clear selection

If I were to research some information for you and send you links to that information, would that be helpful for you? Would you be able to take the time to read the information?

Yes

Maybe

Clear selection

What would be your favorite and most effective way to learn new information? Check all that apply.

Reading (digital)

Reading (hard copy)

Listening (podcasts, audio books)

Watching (videos, webinars)

What health strategies have you tried in the past that have worked well for you?

What health strategies have you tried in the past that have NOT worked well for you?

Thank you! I can't wait to talk with you about your wellness goals! Please click the link below to schedule your free consult call if we have not already done this.

https://calendly.com/mandysawyer/15mindiscovery

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