Lifestyle Questionnaire Form

Discover You CanThis lifestyle questionnaire is your first start at evaluating how you can use your strengths and address your common barriers to help you stick with your plan!

Be honest!  It’s okay to admit you may have a few barriers!  There are ways we can work together to help you overcome these!



Tell us as much as you can about you, your history and your current goals so we can help you identify changes that will feel good in your lifestyle.

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