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* 1. How old are you?

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* 2. In general, how would you rate your overall health?

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* 3. How would you describe your ideal state of health and wellbeing?

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* 4. What is your biggest health concern (or goal) currently?

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* 5. What do you feel is holding you back?

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* 6. How do you feel you could benefit from working with a holistic health coach?

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* 7. Which of the following are you most interested in? (choose one)

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* 8. Which of the following would you like to learn more about: (check all that apply)

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* 9. If you were/are looking to partner with a holistic health coach to work with you to improve your life experience, what frequency would you be interested in and would be most beneficial?

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* 10. If you could ask me anything, what would it be?

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