Client Application

Tell me about yourself...

First name

Last name

Phone

Birthday

Month

Day

Year

Gender

Male

Female

What brings you to Vitality?

Have you ever worked with a nutritionist, health coach, or personal trainer before? If so, what services did you receive? What were you happy with? What did you dislike?

What are your primary concerns/goals?

Have you been diagnosed with ANY conditions (mental, physical, etc)? Even something as small as headaches or high blood pressure is relevant here. List concerns from greatest to least importance, please.

Are there any biomarkers you would like to improve if possible? For example: Inflammatory markers, blood glucose, cholesterol, etc

Regarding to your health, wellness, and fitness, what have you tried already? What has worked? What has not worked?

Tell me a bit about your daily life... Family, Work, Friends, etc.

Rate your level of stress from 0-10. What are your largest causes of stress? How do you manage stress currently?

Tell me a bit about your relationship with food and your eating habits. There is ZERO judgement here! I am here to support you on YOUR journey!

Are you familiar with the health benefits of a whole foods, plant-based diet for a multitude of conditions? Are you willing to make necessary dietary changes and using a food as medicine approach to improve your health and biomarkers?

Tell me about your activity level, relationship with movement or dedicated exercise, and any injuries or conditions that can inhibit your movement.

How many hours of sleep do you get per night?

How much water do you drink per day?

If you could envision yourself living with the most vitality you could, what would that look like?

What are you hoping to gain from a coaching relationship and your time in a coaching program?

On a scale of one to ten, how ready, willing, and able are you to invest in your physical, mental, and emotional well-being?