Wellness Boot-Camp Survey
Please take a few minutes to fill out the form below. The better you fill it out, the better I can serve you.
I appreciate you taking the time to fill in your answers. I look forward to working with you over these next 10 days.
10 Day Wellness Survey
Name
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First
Last
Email
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Phone
Is this your first time joining My Wellness Boot-Camp?
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Tell me a little bit about a day in the life of YOU?
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How would you rate your nutrition on a scale of 1 to 10 with 10 being. " I have awesome nutrition habits and 1 being, I'm a hot mess with my nutrition" ?
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What do you feel you struggle with most? Nutrition? Exercise? Accountability? Consistency? Mindset? All of the above. AND WHY?
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Check all that apply to you
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Thyroid Issues
Chronic Fatigue
Trouble Sleeping
Digestion Issues
Lack of Sleep
Lack of Energy
Mood Swings/ Depression
Chronic Inflammation
Chronic Headaches
Poor Nutrition
What are your current goals and how can I best help you reach them?
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If you had a magic wand what is the 1 MOST IMPORTANT thing in your health and wellness that you would fix? Explain WHY you would fix it and HOW it would change your life.
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