• New Client Questionnaire

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  • Please rate the following areas of your life on a scale of 1 to 10, with 1 being very poor and 10 being excellent.

  • Life Coaching is also about life balance. The skills for creating what you want in one area of life will transfer to other areas. For each of the life areas below, write down what you would like to achieve as specifically as possible. Be as extensive as you’d like. 

  • Life Overview

    Physical Health

  • Symptoms

    If you never experience the following symptoms, mark “0.” If you experience them occasionally, mark a “1.” If you experience them frequently, mark a “2.”

  • Cardiovascular

  • Muscular

  • Respiratory

  • Skin

  • Gastrointestinal

  • Immune System

  • For each of the statements below, if the answer is "yes" check the box.

  • Should be Empty:
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