Lifestyle Assessment

Please take a 10-15 minutes to answer the following questions as completely as possible, to help us get the most out of our time together so you get the greatest benefit possible from our call.

All information shared here and on the call is 100% confidential, and will help us to nail down the right steps and strategies to build holistic wellness into your lifestyle.

Let's Get to Work

Phone (if you'd like text updates)
Challenge of Choice: What area of your lifestyle would you like to focus our coaching sessions on?*
Describe your current lifestyle challenge: What have you noticed? How is this challenge impacting your wellbeing? What resolutions have you tried already? Why do you think it did or didn’t work? Be as descriptive and specific as possible.*
 How long have you noticed this challenge? (e.g. Weeks, Months, Years)*
Share the the key elements in your story to date. Please include: Basic Needs Met?, Work-Life Balance, Relationship with: Self, Food, Others, Technology, Money*
If you could wave a magic wand, what transformation of this challenge look like?*
Obstacles: When looking at where you are vs where you want to be, what do you feel has held you back the most? *
If you answered 'Other' for obstacles please note here
On a scale of 1 - 10, How prepared are you mentally, emotionally, financially, to invest in yourself and your business to see the results you want within the next 90 days? (1 = not ready and 10 = LET'S GO!)*
Do you have time to dedicate to consistent coaching and implementing what we discuss in between each session?*
What have you tried so far? Include any coaching programs, paid training, marketing strategies, etc*
What, if anything, do you feel has worked best for you so far?*
What, if anything, do you feel might stand in the way of the success you seek?*
By submitting my contact information, I agree to receive email and/or sms updates from To Breathe Again.

...so you can get the results you came for.