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

Apply for a complementary 1:1 assessment
(Normal $350 value)
start
 
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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