Name & contact info Name Email Phone Age Your current health How many hours a day do you devote to... work? sleep? exercise? leisure? socializing? What is your average stress level on a day to day basis? What is your current level of fitness? How do you approach food? ( i.e. organic everything, the occasional farmer's market, or fast food because I don't have time) How often do you drink alcohol? How important are family, friends, socializing or relationships? Do you take or use all of your vacation days? On a scale of 1 to 10, how would you rate your happiness? When you stand naked in front of the mirror your first thoughts are... Have you ever accomplished something that everyone said you could not do? What inspires you? What type of motivation do you respond to best? What is the coolest thing about you? Your future life What is your ideal level of health... work? sleep? exercise? leisure? vacation? Just a bit more... Have you ever meditated before? If so, what type? What are your three most frequent complaints? (i.e. tired, stressed, sick, emotional) What was the healthiest point in your life? Describe the conditions surrounding that time. What are the obstacles preventing you from being a healthier, happier person? Do you believe it is possible to achieve all of your goals?