Tell me about your current mindset surrounding your health and how it's impacting your life, work and relationships. How would you describe the current state of your health? *
Your answer
What are the biggest challenges you want my support to help heal? *
Your answer
Where do you see your health and life in 6 months? 12 months? Please be specific on how you want to feel and what you'd like to be different in your life *
Your answer
What makes you ready to work with me right now? *
Your answer
What appeals to you about working with me specifically as your holistic patient advocate? *
Your answer
Are you willing to invest in yourself EMOTIONALLY and FINANCIALLY to create the health changes that you desire? *
On a scale of 1-10, how committed and serious are you about investing emotionally and financially in your health in order to fully heal whatever health issue or symptoms you wish to reverse? *
On a scale of 1-10, how willing and committed are you to doing the everyday work it takes to fully heal your body (diet, mindset shift, stress reduction, sleep, movement, etc) *
How did you first hear about Adrienne / WellBe? *
Your answer
How did you hear about my holistic patient advocacy services? *
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wellbe. Report Abuse