Reignite Your Midlife Passion:
Discover Peace, Purpose, and Possibility
Ladies, Your Time is Right Now!
Gender:
- Male
- Female
- Non-binary
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HEALTH & WELLNESS GOALS
What are your primary wellness goals?
- Stress management
- Emotional balance
- Improved sleep
- Managing Change
- Overall Wellness
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SERVICE PREFERENCES
Which services are you most interested in? (Check all that apply):
- Holistic health coaching
- Somatic Healing
- Private Meditation
- Retreats
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Preferred Appointment Time:
- Morning
- Afternoon
- Evening
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HEALTH HISTORY
Do you have any medical conditions or injuries we should be aware of?
- Yes
- No
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Are you currently on any medications or treatments that may affect your wellness plan?
- Yes
- No
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