General Questions - Simply Mindful

Before we connect, I’d love to know a bit more about your needs to make sure I’m the right partner to help you reach your wellness goals. Please answer these quick questions, and I’ll be in touch very soon!

1. What is your top priority concerning your health/well-being?(Required)

2. Are you experiencing specific health conditions you are especially concerned about?(Required)

If yes, please share. If no, simply state no.

3. Do you currently have a primary care doctor?(Required)

Yes

4. How comfortable are you with doing personal work in the area of self-awareness, self-care, and learning about your body?(Required)

Please share to the best of your ability.

5. Are you open to trying new things?(Required)

Not at all

Somewhat

Definitely

6. Are you able to set aside dedicated time to improving your well-being?(Required)

7. What is your first name?(Required)

8. What is the best email address to contact you?(Required)

Your name and email address will not be used for any purpose other than answer general questions regarding my services.

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Phone

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