Let's Get in Shape!
Home
Join The Glow Up Society >>
Fill out the questionnaire below to begin then pick your time on calendar:
First Name
Last Name
Email
Do you currently have a business or consider yourself an entrepreneur?
Yes
No
If you are an entrepreneur, how long have you been in business?
0-3 years
4-7 years
8+ years
Have you ever worked with a health coach before?
Yes
No
What are you currently struggling with? (select all that apply)
Confidence
Weight/appearance
Being happy
Self-limiting beliefs or negative self-talk
Accountability and support
Self-sabotage
Overating
Learning how to eat healthy
Lack of motivation
Showing up or being present
Energy
Constant approval seeking
How much weight would you like to lose?
0-20
21-40
41-60
61-80
81-99
100+
List any physical/medical ailments or conditions:
As a life coach, do you understand that I cannot diagnose, treat or provide medical advice?
Yes
No
Are you currently seeing a counselor, therapist, psychologist or other mental health professional?
Yes
No
Have you been diagnosed with clinical depression, ADHD or any other condition?
Yes
No
Name your #1 goal from health coaching:
Let's Get this Body Together!
Copyright 2021. Natalie Butler. All rights reserved.