(don't use) Connection Call Survey

Please fill this out & book a call when you've finished

First Name

Last Name

Address

Phone Number

Occupation

Please list & describe your current challenges, symptoms or pain (physical/mental/emotional)

How ready are you to overcome these challenges, change your lifestyle habits & facilitate change in your life?

What would you like the most support with?

How would you describe your current mindset & emotional health?

How would you describe your self-talk/internal dialogue?

How would you rate your current physical health & health habits 0 (not healthy)-10 (Extremely healthy)? Please explain?

Tell me something you absolutely love about yourself

What are your current goals/intentions & what barriers are standing in your way of achieving them?

How much are you willing to invest in yourself MONTHLY to start living a life that brings you love, joy, freedom & abundance?

Have you ever worked with a coach or mentor to support you in your growth & healing?

How did you hear about Mind Body With Leah?