Holistic Health and Wellness Questionnaire

Thank you for working with me!

After you submit this questionnaire, you will receive an email with consultation instructions and scheduling options. Choose the date and time that works best for you. I look forward to working with you and helping you reach your goals.

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Please be as thorough as possible when answering the following questions so we can maximize our time together.

Name(required)

Email(required)

Thank you for choosing to work with me. What do you hope to accomplish through our collaboration?

What do you currently do to take care of your health and wellness?

What would you like to improve the most about your health?

Do you feel comfortable and confident making decisions about your health and wellness?

How would you rate the level of stress you currently experience in your life?

Do you have a good support system or community group in your life?

Do you currently have a space in your home where you can go to be alone?

Have you ever practiced complementary therapies such as yoga, meditation and aromatherapy?

If you responded "no" to the previous question, are you willing to try complementary therapies?

What additional questions or concerns do you have related to your health and wellness? Please share as much detail as possible.(required)

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