Please fill out the following survey to help us organize your file and improve our systems!

Name *
Phone Number *
Phone Number
Birthdate *
When did you first visit our office? (estimated date is fine!)
When did you first visit our office? (estimated date is fine!)
Please check all the reasons you made an initial appointment:
What was most helpful about the first appointment?
How often do you visit our office currently?
How often do you eat sitting down?
Do you have a nightly routine?
Do you meditate?
If we created a wellness plan for you, please check what food value/strategy applied:
How much water (including decaffeinated beverages) do you drink?
Caffeine Consumption:
Alcohol Consumption:
Are you taking any supplements?
How often do you eat at restaurants?
If you track your food, please check the method you use:
Do you identify with any of these statements? (mark all that apply)
Do you have diabetes or hypertension?
Are you on a statin?
Do you have any of these hormonal conditions?
Do you have any of these conditions that impact digestion?
Do you have any of these health conditions?
Do you or have you struggled with these mental health conditions?
Have you gone through weight loss surgery?
Which Wellness Coach have you met with?
Would you be willing to see another coach if Sarah Lynn is not available?
Your wellness goals and history will be shared with this coach prior to meeting.
Are you a member of one or more of our Facebook support groups?
If you follow our Instagram page, what posts are most helpful?
Are you interested in receiving a weekly email blast with 1-2 recipes or products and an interesting article on wellness or nutritional science?
The cohort would consist of 4-5 clients and one Wellness Coach. The purpose of a small group cohort is to provide a space to share similar struggles/triumphs/ideas. It would also have a financial benefit: more time for less money.
Which of the following a la carte services would you be interested in?
Please check all that apply. We recognize that cost may be prohibitive but check what interests you.