Energy Reboot Assessment
Application Form
*(All sessions are private and confidential)*

Apply for a complementary 1:1 assessment
(Normal $350 value)
Briefly describe your current health or life concerns? *

Exhaustion, Anxiety, Overwhelm, Overweight, Work/Life Balance etc
If you could wave a magic wand and change 3 things in your health or life over the next 6-12 months, what would they be? *

Tell me about your work and lifestyle:

How many hours do you work each day or week? *

When was your last holiday/ vacation? *

Do you have a self-care routine? If so, what? *

What have you tried in the past to reach your goals? *

Who or what is your biggest obstacle in reaching your current goals? *

On a scale of 1 to 10 how important is investing in a real solution so you can feel your personal and professional best? *

Full Name: *

Business name or Job Title *

Country/ city? *

Mobile Number *

Yes, if I qualify, I will make every effort to schedule my 1:1 assessment within 2 days of being notified. I understand if I don’t, I will forfeit my session. *

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