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Nutrition Therapy
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Mission & Vision
About
Services
Fitness
Nutrition Therapy
Neuro/Z-Health
Yoga
Emotional Freedom Experience
Offerings
MIT Workouts
Books
Recipes
Let’s Connect
Client Questionnaire
Fill out the form below.
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Name
*
First
Last
Email
*
Phone
How did you hear about Missi & the philosophy of Whole Life Health? If you were referred by someone, please share their name.
Areas of Interest (Check all that apply):
Nutrition Therapy
Fitness Training
Neuro-centric Training (Z-Health)
Yoga
Emotional Freedom Experience
List three words or phrases that describe how you feel about your physical health:
List three words or phrases that describe how you feel about your emotional health:
List three words or phrases that describe how you feel about food:
List three areas of joy currently in your life:
List three stressors or challenges currently in your life:
When you were growing up, food and exercise were:
List 3 words or phrases to describe your mental/cognitive health.
List 3 words or phrases to describe your relationship with yourself.
List 3 words or phrases others would use to describe you.
List 3 words or phrases to describe your passions; what lights you up?
Share a favorite hobby, sport, or activity that you enjoy deeply.
Thank you for taking the first step in reaching your goals!
Submit
Below are the forms needed for client participation.
Personal Health History
Exercise History
Consent & Disclaimer