Name
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First Name
Last Name
Email
*
Which of the following statements *best* describes your current relationship with your health?
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Piggybacking on that question, tell us how you feel right now. In terms of your health, energy, mood, stress level, etc., give us the Cliff Notes, filter-free rundown on where you currently stand:
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Moving on to your lifestyle, on average, how many hours a night do you sleep?
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What about your nutrition? Which of the following *best* describes your eating patterns?
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In terms of moving your body, which of the following statements *best* describes your motivation to workout:
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Ok, now let’s talk about how you recharge your batteries. Describe what that looks like for you and tell us the last time it happened:
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Big question: Do you feel supported?
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We asked you at the beginning how you currently feel. If you’d like to feel differently, how would you describe that? What does it look like? What elements of your life would be different? This is essentially a magic-wand type of question, so anything goes:
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One last question! For our event, we will be providing you something to sip on. What's your preference?
Red wine
White wine
No preference
I personally will not partake
