Phone. Video. Email. In Person. Coaching PRE Assessment

Please complete this short assessment at the beginning of your participation in your health coaching program.

The information you provide in this pre-assessment questionnaire will be used to support the development of a personalized health and wellness coaching plan tailored to your individual needs and goals. All personal data will be treated as confidential and handled in accordance with applicable privacy standards. Additionally, anonymized and aggregated data from participant assessments may be used to evaluate the effectiveness of our coaching services and to inform program development. No personally identifiable information will be included in any reports or summaries used for these purposes.

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* 1. Member Information

Name

Employer

Email Address

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* 2. How confident are you in your ability to make and maintain healthy lifestyle choices?

Not at all Confident

Somewhat confident

Confident

Very Confident

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* 3. How would you describe your current overall health and wellbeing (physical, mental and emotional)?

Very poor

Poor

Fair

Good

Excellent

Other (please specify)

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* 4. In the past month, how often have you engaged in behaviors that support your health goals (e.g., physical activity, healthy eating, stress management, adequate sleep, etc.)?

Always

Often

Sometimes

Rarely

Never

Other (please specify)

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* 5. How ready are you to make changes to improve your health and wellbeing right now?

Not Ready

Thinking about it

Preparing to make changes

Taking Action

Maintaining Changes

Phone. Video. Email. In Person. Coaching PRE Assessment

Question Title

* 1. Member Information

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* 2. How confident are you in your ability to make and maintain healthy lifestyle choices?

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* 3. How would you describe your current overall health and wellbeing (physical, mental and emotional)?

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* 4. In the past month, how often have you engaged in behaviors that support your health goals (e.g., physical activity, healthy eating, stress management, adequate sleep, etc.)?

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* 5. How ready are you to make changes to improve your health and wellbeing right now?

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* 6. What is your biggest challenge when it comes to your health and wellbeing right now?

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* 7. Please provide your Health Coach's Full Name.