Discovery Path

Assessment for Your Wellness Consultation

Discovering YOUR Path to Wellness!

As Wellness and Lifestyle Consultants, we are here to link arms with you and help you discover YOUR path to YOUR BEST YOU, by building an action plan towards obtainable & sustainable goals.

You're almost ready for the next step to kickstart your progress. By answering the questions below, you will give us insight towards your wellness needs. When completed, simply hit the SUBMIT button below.

We’re excited to connect with you and help you reach your goals!

Marital Status

Single

Married

Divorced/Separated

Widowed

Living with my significant other

Prefer to not answer at this time

Number of Children - natural or C-section*

Hobbies and Leisure activity

Physical Activity

1. Daily - I make time for physical activity every day

2. Several times a week - I engage in physical activities multiple times throughout the week.

3. Once a week - I dedicate one day per week to physical activity.

4. Occasionally - I fit in physical activity when I can, but not on a regular schedule.

5. Rarely - I seldom participate in physical activity.

6. Not at all - Physical activity is not currently part of my routine.

Alcohol or drug use -

Do you currently have health concern or condition that you would like to share? If yes, then please explain them below:

List any current medications you are taking:

Mark the supplements you are currently taking?

Multivitamin

Omegas

Probiotics

Calcium

Digestive Enzymes

Vitamin C

B Complex

Minerals - Magnesium

Protein Drinks

I'm currently not taking any supplements.

List any supplements you take that are not included in the list above.

Check all the areas that apply to your current health goals. (where you would like to see improvement)

Anxiety/Mental Stress

Emotional Balance

Cardio Health - Cholesterol, Blood Pressure

Cognitive Support - Brain Health

Detoxification

Digestion/Gastrointestinal

Energy Support

Excretory - Kidney & Bladder

Hormone/Endocrine Systems

Hydration

Immune Support

Inflammation

Lymphatic System

Mobility & Joints

Muscular/Skeletal

Sleep Support

Skin, Hair & Nails Health

Skincare & Aging

Workout/Strength Support

Spiritual Enrichment

Weight Management

Diet & Nutrition

Toxic Stress

Other

On average, how many hours of sleep do you get a night?

Less than 5 hours

5-6 hours

6-8 hours

More than 8 hours

Which description below best describes your sleep experiences.

Difficulty falling asleep

Waking up frequently during the night

Trouble staying asleep

Waking up too early and unable to fall back asleep

Feeling tired upon waking

I have no sleep issues I sleep well and wake up fully rested everyday.

Typical Daily Diet - Describe as close as you can your typical daily meals. Include meal times, types of food (processed foods, sugars, any dietary sensitivities, typical meats & proteins, fresh vegetables, fruits etc.

Which of the following would you be willing to focus on when creating your wellness plan? (pick multiple)

Dietary nutritional additions or changes

Supplements that offer the best bioavailability for my body

Essential oils for whole self wellness

Toxin Free household cleaning

Pantry makeover

I'm open to all holistic wellness options, please!

Have you tried any plans or programs in the past to address these areas. What were they and what were the results?

How motivated are you to make lifestyle changes? (scale of 1-10)

1 - Not At All Ready: "I'm not quite ready to explore wellness options right now."

2 - Curious: "I've heard about wellness, but I'm not sure it's for me yet."

3 - Open-Minded: "I'm interested in learning more and open to hearing about potential benefits."

4 - Exploring Options: "I'm exploring different wellness solutions and interested in what you offer."

5 - Beginning to Dive In: "I can see some benefits and want to try a class or two."

6 - Ready for a Change: "I'm ready to invest a bit more time into wellness with your guidance."

7 - Seeking Support: "I'm eager to commit to a wellness plan and would like more personalized advice."

8 - Taking Action: "I've decided to embrace wellness practices and want to start with a session."

9 - Dedicated to Wellness: "I'm ready to incorporate wellness into my regular routine."

10 - Sign Me Up Right Now: "I'm all in! Let's start this amazing journey together."

What are your biggest challenges in achieving your wellness goals?

Procrastination

Fear of Failure

Overwhelm

Lack of Motivation

Poor Time Management

Negative Mindset

Lack of Support from Family or Friends

Ineffective Planning

External Distractions

Have you ever considered using natural non-toxic home products?

Yes

Possibly, I would like to hear more on this topic.

Are you willing to adjust your lifestyle and/or environment to prioritize your health?

Yes, I'm willing to make adjustments to my lifestyle.

Yes, but I like to take baby steps towards any changes I do.

No, I'm not there yet.

Maybe, I will need more info on what the adjustments are before committing.

Are you willing to commit to 3 months towards your wellness goals?

Yes

Maybe, I want to learn more before I decide.

Are YOU ready to take control of your health?

YES! I'm ALL in!

Yes, I'm ready to get started with my Free Consultation and then I will decide my next steps.

Not sure: however, I would like to learn more about how I can improve my health.

I have questions I need to ask before deciding.

I'm just not ready to make the commitment right now. But, want to in the near future.

No thank you, I'm not interested.

Which of these statements best describes you:

I'm easily overwhelmed by choices and information.

I'm all in. Just tell me what I need to do.

I like a little information at a time.

I want to hear testimonies and reviews to see what others are experiencing.

Give me all the info and I'll read on my own.

I'm really need accountability and guidance towards my options and goals.+

I'm well informed on holistic health.

Which topic's interest you the most? (pick multiple)

Essential Oils - What, Why and How to Use?

Body Support - Bones, Muscles & Ligaments

"Essential Skin Nourishment"

Empower Health - Raindrop Massage Technique Demonstration

Gardening with Oils

Make a Shift - Happy, Healthy Home - Ditch Household Toxins for Clean Alternatives

Harmony Within: Support for Optimal Wellness - Hormonal & Endrocrine support

Immune System Upgrade

Unsung Hero's - Supplements for Support

Oils of the Bible

Power of Nutrition for Happy Bodies!

DIY's Budget Stretching Tips and Tricks

Hair, Skin and Nail Care

Teeth & Oral Care

Products for the Gym and Workout Recovery

Essential Oils and Emotions

Energy Boost

Well Care VS Sick Care

Sleep Support

Aging Backwards & Collagen

Weight Management

Mom & Baby

Cooking with Essential Oils

Preferred method of contact regarding this consultation (pick one)

Talking on the phone.

Talking via text.

Zoom meeting

other

Please add any additional questions or comments you have!.

Thank you for taking the time to fill out this form.

I look forward to chatting with you soon!