Questionaire

Date

First Name

Last Name

Address

State/County

Zip/Postcode

Phone Day

Phone Evening

Mobile Number

Skype Address

Date of Birth

Occupation

Relationship Status/Support

Children

Current Weight

Weight One Year Ago If A Concern

Passions/Interests/Hobbies

Favourite Way to Spend Your Free Time

Health & Life Information:

Where are you now?

Why have you chosen to invest in yourself and this time?

Is there an area of your life where you feel specifically stuck?

At what point in time did you feel at your best?

Please state clearly what you would like to discuss in this coaching session/package.

What is your ideal outcome?

Where are you with your raw food journey?

Please detail your current diet:

How would you like to eat and why?

How would you like to feel about your body ? How would you like to look ?

What do you feel is stopping you from eating the way you wish to ?

Do you classify yourseld and an eating type?

Is your eating pattern affected by your hormonal cycle? Do you know?

Have you any health issues/challenges/allergies/sensitivities/minor operations I need to know about?

Have you ever fasted/carried out a Cleanse or Detoxification program?

Do you know what real hunger is?

Reflecting upon your present life please rate each area indicated here on a scale of 1-10.

Food & Diet

Health, Physical Body, Exercise

Relationship to your Body

Emotional Self

Personal Growth

Spiritual Journey

Relationships/Partner

Money/Money Relationship

Professional Life/Career

Recreation/Hobbies

Laughter/Fun

Family/Friends

At this present time in your life what do you most Aspire too.

Do you currently consult other professionals?

How can we and I make the most positive impact on your life during our first call?

What positive results would be visible in your life that would show that the value of the coaching s

. Anything else I need to know?

What Metaphor would you us to describe your pathway in life to date:

Are you a Glass half full kind of person or a Glass half empty kind of person?

Thank you for this precious time of reflection. Please have this available for our coaching calls. Speak Soon,
Laara

CLAIM YOUR FREE ONLINE RETREAT NOW: CLICK HERE FREE ONLINE RETREAT

It`s Your time

Contact Details

Connect with me