The 8th Element - Online Nutrition, Lifestyle, & Weight Loss program using Science, Habits & Mindful Eating
Dear Strong & Proactive Friend,
Thank you for reaching out to me for help with transforming your lifestyle and habits. Please take your time to reflect on these questions and share your challenges in as much as detail as you can. I appreciate your openness and trust. Your information is safe with me.

Your goal is my goal, and I'm here to support you wholeheartedly as you strive to:

🌟 Seize control of your life, transforming your well-being inside out 

🌟 Cultivate lasting habits that pave the way for sustainable success 

🌟 Foster a harmonious relationship with nutrition, body, mind, and exercise 

🌟 Craft a holistic system—embracing nutrition, exercise, sleep, stress management, and mindset—for lifelong vitality, not just fleeting weeks 

🌟 Elevate your health markers, nurturing a stronger, more resilient you 

🌟 Ignite unshakable confidence, radiating in both personal and professional realms 

🌟 Revel in an energetic life, cherishing precious moments with your loved ones and pursuing your passions unreservedly 

🌟 Shine as a role model, becoming a beacon of positive change in the world around you

I'm eagerly anticipating our in-depth conversation, where we can delve into the possibilities of embarking on this transformative journey together. If everything aligns, I look forward to holding hands with you through your entire journey. 

Sending warm hugs your way,

Coach Srividya

Sign in to Google to save your progress. Learn more
Email *
Full Name *
Gender *
Age *
Phone number *
Do you work? If yes, which organization? *
City *
How did you hear about me? *
If referred by someone, please share his/her name here so I can send a thank you note. :)
What was it about my approach that seems to align with what you want for yourself? What made you think I would be able to help you in your health & fitness journey? *
Your current situation - Please check ALL your challenges from the list. *
Required
Name any health issues I should be aware of.
For eg. Pre-diabetes, Diabetes, High Cholesterol, High BP, PCOS, Hypothyroidism, Joint pains etc.
*
In what way do they affect your day-to-day life and functioning? *
Health & Fitness goals - What do you want to achieve in the next one year?

 For eg. lose weight, gain weight, improve biomarkers - cholesterol, blood sugar, eat better, look better, get stronger, move better, improve energy, improve confidence, sleep better, manage stress better
*
What efforts are you making currently towards reaching your goal? What have you tried in the past? What worked, what didn't work? *
What is stopping you from reaching your goals by yourself? Name all the roadblocks in your way. *
How ready, willing & committed are you to work on those roadblocks so you can make progress towards your goals? *
Not a priority right now
I'm desperate to change
FAMILY SUPPORT - How would you rate your family support for decisions relating to your health & fitness on a scale of 1-10?  *
No Support
Very supportive
Are you ready to invest in your self-care & hire a coach and start taking action to fast-track your progress?  *
Not at all
Extremely
Do you understand that a sustainable lifestyle change and unlearning old habits & building new habits take time? Are you willing to commit to a minimum of 3 months to start making progress towards the outcome you want for yourself? *
Thank you so much for taking the time to reflect on the questions and share your answers openly with me. I really appreciate your trust.

I will review your answers and get back to you within the next 24-48 hours to set up our call to discuss in-depth and arrive at a sustainable solution that would potentially work for you.

If you are not the decision maker for all decisions relating to your health, please talk to the decision maker in your family about this sustainable approach towards lifestyle change and get their buy-in. 

Please feel free to invite them on this call to make it easier for us to come up with the decision collectively and help you start taking action towards your goals without any further delays.

Hope this resonates with you.

- Coach Srividya.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report