Strategy Session Intake Form

Thank you for taking the time to fill this out prior to your initial session.
All information will be kept confidential.

First Name:

Last Name:

Email:

What is you main health concern?

What have you done in the past to work on this health condition? (western or eastern modalities)

What has proven effective?

What is your current diet like?

Are you taking any supplements?

Where would you like your health to be 3-6 months from now?

What challenges and struggles do you come up with regarding diet/lifestyle?

What are your 3 BIGGEST obstacles to being in your peak health?

What do you hope to get out of our work together?

What are 3 things you LOVE about your life?

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