30 Minute Break Through Session Form

Name

Email

Phone

Time Zone

1. What is your main health concern?

2. What have you done in the past to work on this? (Western or eastern modalities)

3. What has proven effective when working on this health concern?

4. What is your current diet like? List what you generally eat for breakfast, lunch, dinner, snacks, and beverages Also, list approximate times you eat.

5. Would you describe yourself as a fast eater, slow eater, or moderate-paced eater?

6. What is your desired long-term health goal?

7. How can Caitlin best help you?

8. What questions do you have for Caitlin?

9. What three things in your life are most important to you?

Once you click submit, I will receive your information which will help me zero in on what is most important to you, so thank you for filling this out!

Talk with you soon,
Caitlin

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