Email

Age

What does "vitality" as a woman mean to you?

What core beliefs do you hold about health and healing? Where do these beliefs stem from?

Describe a day in your future most "vital life".

What are you aiming for your most "vital life" to look and feel like on the day-to-day?

What is currently going REALLY WELL for you in your current life?

What brings you joy, satisfaction, fulfillment? Moments you feel at peace, content, at home with yourself and your body.

What was your motivation to purchase a Vitality Consult?

What is your current understanding of Quantum Health?

Medical History

List your medical history from birth to present. List past use of medications, antibiotics, birth control.

Past Symptoms and Stress

List ANYTHING that has happened in your physical/mental/emotional/spiritual life that was not your definition of “optimal." This can include things that were overlooked by others. Include when the symptom/stress began and resolved.

Current Medical Diagnosis

Current Symptoms and Stress

List ANYTHING that has happened in your physical/mental/emotional/spiritual life that was not your definition of “optimal." This can include things that were overlooked by others. Include when the symptom/stress began.

Current Medications and Supplements

What methods of health and healing have you tried in the past that have worked?

What methods of health and healing have you tried in the past that have NOT worked?

Decsribe your menstrual cycles over the last 3 years.

Frequency, duration, symptoms, etc.

Nutrition Diary

List ALL of the foods and drinks you partake in over a 7 day period.

Describe your physical and emotional relationship with food.

How do you feel physically and emotionally before, during, after meals?

Describe your thought life.

What do you "think" about yourself throughout the day and night?

Describe your work/job in this season of life.

Are you satisfied? Fulfilled? What would you change? Why or why not?

Hours Per Day Spent Working:

Hours Per Day Spent Moving/Exercising:

Hours Per Day Spent Outside:

Hours Per Day Spent on Technology:

Phone, TV, Computer, Etc.

Hours Per Day/Night Sleeping:

List 3 tangible, measurable goals you hope to meet in your vitality journey.

How long do you expect it to take to reach these 3 goals in your vitality journey?

How do you measure "success" and "it's working" when it comes to health and healing?

What do you feel will be the greatest road block(s) of your "success" in your vitality journey?

Any limiting beliefs? Emotional, physical, energetic, spiritual strongholds? Etc.

Are there any aspects of faith and spirituality that you are hoping to bring into your vitality journey? If so, explain.

Anything else you would like me to know before our first session?