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About
Weight Loss Services
Programmes
Areas we specialize in
Conditions Addressed
Articles
Questionnaire
Shop
Contact
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Discovery Call Questionnaire
Holistic Well-being, Mindset & Lifestyle Coaching
Welcome! Please take a couple of minutes to complete this simple questionnaire. Your answers remain
completely confidential and help ensure we focus entirely on your unique goals and needs during our upcoming call
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Please enable JavaScript in your browser to complete this form.
1. What is the primary reason you are booking this discovery call? (Select all that apply)
Improving my daily habits & lifestyle
Managing stress, overwhelm, or mindset barriers
Navigating menopause or hormonal changes
Reaching a healthy weight / dietary support
Managing a specific health condition
Other
Specify Other here
2. Are you currently experiencing symptoms of peri-menopause or menopause?
Yes
No / Not applicable
I am not sure, but I suspect I might be
3. Do you have any diagnosed medical or health conditions?
No
Yes
This ensures our approach is completely safe and fully aligned with your medical profile.
If yes, please briefly list
9. are is
4. Have you ever tried weight loss medications or structured dieting programs?
No, I have not tried weight loss medications or clinical diets.
Yes, I have used weight loss/dieting medications in the past or currently.
Yes, I have tried structured commercial diet plans (e.g., shakes, calorie points, pre-made meals).
5. Just for fun — what is your absolute favorite food?
*
No judgment here! I love connecting with the real you.
6. How would you describe your ethnicity?
*
This helps me understand any cultural dietary frameworks or specific physiological health predispositions.
7. What do you feel is your single biggest obstacle to feeling your best right now?
*
Lack of time / balancing a busy schedule
Consistency and staying motivated long-term
Confusion over what to do or where to start
Emotional eating, cravings, or stress-related habits
8. What are you looking to gain most from working with a professional coach?
*
A clear, step-by-step practical action plan
Compassionate, structured accountability and support
Deep mindset shifts to break through old behaviors
9. On a scale of 1 to 10, how ready are you to make positive changes in your life right now?
*
--- Select Choice ---
1
2
3
4
5
6
7
8
9
10
1 = Just exploring options; 10 = Fully committed & ready to start
10. Is there anything else you would like to share before our conversation?
Submit
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