Incarnational Wellness - Health Coaching Audit
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Name
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Email
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Mobile Phone
Today's date (MM/DD/YY)
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How did you hear about Incarnational Wellness?
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Health History
This section helps me understand where you are currently with your health. If you struggle with chronic illness, please respond according to that focus.
Tell me about your current health issues.
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What are the three biggest obstacles for you right now around your health?
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How long has this been occurring in your life?
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What have you tried to do so far to solve this in the past?
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How did that go?
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How would you like to change your health in the next 3-6 months?
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What, if anything, is missing or needed to reach that goal?
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Why is this something you are interested in solving now?
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How commited are you to dedicate time, energy, and resources to reach your goal right now?
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Please select one option.
Yes, I'm ready for change and am willing to invest time, energy, and resources with a commitment to imrpove my health.
I have limited resources but am fully commited to invest my time and energy towards improving my health.
I lack the support system needed to make this commitment in myself.
No, I cannot invest time, energy, or resources in myself right now.
How did you learn about Incarnational Wellness?
Please add me to the following mailing lists:
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General mailing list - receive newsletters and announcements
Prayer team - receive occasional prayer updates and prayer requests
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