Discovery Call Intake Form | Catalyst Wellness Coaching LLC

Why are you reaching out to a Health Coach? What specific health and wellness results would you like to see within the next 6 months or so?

How would your life be different if you were to achieve these health changes?

How do you feel a health coach will help you achieve your goals? What can I provide that would be most helpful?

Coach-ability Self-Assessment

On a scale of 1-5 please rate whether you agree or disagree with the following statements:

1= Strongly disagree 3= Unsure 5= Strongly Agree

I am open-minded about learning new ways of eating, moving, and living

I can commit to changes that feel uncomfortable, unusual, or unconventional

I will communicate and negotiate with my health coach as an equal partnership, and feel confident to ask for what I need

I understand health coaching is an investment in myself for positive long-term change

Please list 3 things you've tried in the last 2 years that have improved your health

Please list 3 things that you've tried that have not worked

What is your current body weight?

What is your current height?

What is your ideal body weight?

Any pre-existing medical or mental health conditions I should be aware of?

What medications and/or supplements do you currently take?

What have been your barriers to creating health changes?