About You

Please help me get to know you so I can custom-fit your coaching.  Provide the information you feel comfortable sharing.  Please be as honest as possible.  Your answers will be kept strictly confidential.

Are you currently suffering from a medical condition, illness, or injury?
Have you been hospitalized in the last 12 months?
Physical symptoms you have been bothered by within the past month:
Mental/Emotional Symptoms you are bothered by:
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Thank you!