Initial Assessment & Triage Questionnaire

Initial Assessment & Triage Questionnaire

By learning more about your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for your goals and individual needs.
Please print clearly.
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Yes or No
Yes or No
Yes or No
Yes or No
Think about all the activities you’re involved in (e.g., work, school, caregiving, housework, travel). Then assess as best you can: