Health Coaching Intake Form

Please complete the intake form below so I can better understand your goals, current health status, and readiness for coaching. This information allows me to determine how best to support you and ensure that coaching is aligned with your needs.

Health coaching is a collaborative process focused on building sustainable habits related to nutrition, lifestyle, and overall wellness. This intake is not a medical evaluation, but it helps establish a clear starting point for your coaching journey.

Once your intake is submitted, I will review your responses and contact you within 24 to 48 hours to discuss next steps, including coaching options and scheduling.

All information shared is kept confidential and used solely for coaching purposes.

What Happens Next:

• Your intake will be reviewed personally

• You will be contacted via email regarding next steps

• If appropriate, we will schedule an initial coaching session

• You will receive guidance on how to prepare and what to expect

Before You Begin:

Please answer the questions honestly and thoughtfully. There are no right or wrong answers. The goal is clarity, not perfection.