top of page
Home
My Story
Individual Coaching
Learning Hub
Client Log-in
Getting to Know You
Information that Helps me Help YOU!
Please submit before our first consultation
First & last name
*
Email
Birthdate
Month
Day
Year
Are you right or left handed?
Please list your top three areas of concern/focus
Please list any medical issues or concerns including diagnoses, Pregnancy, Implants, Pacemaker, Surgical Mesh, Surgery/Scars, Broken Bones, Spinal Rods/Metal Pins, Advanced Osteoporosis, hypermobility...anything that might be impacted by Block Therapy
Indicate which Block Therapy tools you own (Block Buddy, Block Baby, Block Paddle) and if you have purchased a Starter Program, Membership, or neither
Please explain your experience with Block Therapy. Helpful information is what recent classes you've done, your level of pain, what limitations you have, what challenges you've encountered, and how long you've been doing Block Therapy.
How much time per day can you devote to the practice of Block Therapy? There are no right or wrong answers. This helps me develop the program that best fits your needs within your schedule.
What are your expectations and goals for us working together?
How would you like me to pray for you as you begin your journey?
Give me some insight into your current nutrition plan/way of eating, including food allergies and sensitivities.
Do you have any current struggles with food? What are your biggest challenges with eating healty?answer
What's important for me to understand about your journey with eating, your current weight, or the way you want to go forward with nutrition? What has been misunderstood that you need someone to hear?
Submit
bottom of page
