Let's get to know you

This short discovery form helps me understand your health, your habits, and what you're really hoping for — so the plan I build for you is personal, not generic. Most of it is quick taps. A few questions ask you to slow down and write — that's on purpose.

⏱ 10–15 minutes 🔒 Private to your coach 🌿 Not a medical form

About you

A few quick basics

Nothing here takes long — short answers are perfect.

Full name *

Age *

City

Phone number *

Email (optional)

Occupation

Work pattern

Health snapshot

What's on your plate right now?

Tap anything that applies — answering "none" is completely fine too. A couple of quick follow-ups will appear for whatever you select.

Weight — loss

How long have you been trying? *

What have you tried before?

Any sudden / unexplained weight loss recently?

NoYes

Weight — gain

Since when has this been a concern? *

Any sudden / unexplained weight gain recently?

NoYes

Low energy / fatigue

When is it worst? *

Since when? *

Skin concerns

Skin type *

Main concern *

Where on the body? *

Since when? *

Current skincare / products in use

What seems to make it better or worse?

Did this appear suddenly?

NoYes

Any pain, swelling, oozing or bleeding?

NoYes

Already on a prescribed skin treatment?

NoYes

Family history of skin conditions?

NoYes

Hair fall / thinning

How much would you say? *

Since when? *

Pattern — patchy or general thinning? *

Sleep problems

What's the issue? *

Since when? *

Digestion / bowel movements

Do you experience bloating? *

NoYes

How often does bloating happen? *

Bowel movement frequency *

Typical consistency *

Do you experience constipation? *

Any pain with this?

NoYes

Ever noticed blood?

NoYes

Stress / anxiety

What's mainly contributing to it?

How often do you feel overwhelmed? *

Hormonal / cycle

Cycle regularity *

Any diagnosed condition?

Diabetes / BP / Thyroid

Which one(s), and are you currently on medication? *

Joint / body pain

Where? *

Since when? *

Linked to an injury or sudden onset?

NoYes

Any other diagnosed medical conditions? *

Current medications / supplements *

Known allergies *

Lifestyle

Your everyday rhythm

Quick taps — your honest average is more useful than your "best" day.

Average sleep (hours/night) *

Sleep quality *

Water intake (litres/day) *

Exercise frequency *

Diet pattern *

Caffeine (cups/day)

Alcohol *

Smoking *

Current stress level5

CalmOverwhelmed

Your story

In your own words

"There's no word limit here, and no wrong answer. Take your time — the more honestly you write, the better I can help."

What's really going on, in your own words? *

What have you already tried, and what happened?

Why now? What made you decide to reach out at this point in your life?

If this works the way you're hoping, what does life look like in 90 days?

How important is this to you right now?7

Not urgentTop priority

How confident are you that you can make changes?6

Not confidentVery confident

Anything else you want me to know before we start?

Goals & commitment

What you want, and what's realistic

Top priority right now *

Time you can realistically commit weekly *

Preferred communication *

Budget comfort range (optional)

Almost done

Quick confirmation

One last thing before you submit.

🌿

Thank you — that means a lot.

I'll go through this properly and reach out to talk through what I'm seeing and what I'd suggest. Appreciate you taking the time to really think this through.