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My Story
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Member Login
Please Complete this 10 Question Intake Survey
Name
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First Name
Last Name
Sign-Up Email
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I Struggle With...
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Check All That Apply
Overwhelm
Physical Fatigue
Emotional Sensitivity
Lack or Focus / Concentration
Lack of Motivation
Poor Sleep
Diet & Nutrition
Low Immunity
Low Energy
Other (Please Describe Below)
Please Describe, in Detail, Your Biggest Pain Points:
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What Do You Want to Get Out of Coaching? (Your Goal)
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Describe Your Sleep & Sleep Schedule:
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Please Describe Your Typical Diet:
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Have You Been Tested / Diagnosed with Anything Specific?
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What Does Your Typical Day Look Like?
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What Causes You the Most Stress?
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Select All that Describes You:
Busy Schedule
Perfectionist
A-Type Personality
Controlling
Motivated
Easily Distracted
Lazy
Easy Going
Lost / Confused
Goal Oriented
How Would You Describe Your Personality or Experience When It Comes to Achieving Goals?
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Thank you! Your survey has been sent to MJ.