EmpowerHER Client Questionnaire Hello Lovely!
This questionnaire is your space to share your unique journey and help me understand how we can work together to create the life you envision. There are no right or wrong answers—just honest reflections of where you are now and where you want to be. If you feel like writing a novel, go for it! Let it all out—I’m here for it, girl! The more you share, the better I can support you.
Your Health & Wellness Journey What does "feeling your best" mean to you?
How do you currently care for your physical and emotional health?
What are your top three goals for your health and wellness?
Are there any health conditions, medications, or injuries you'd like me to be aware of?
What does your ideal health and wellness routine look like?
Health, Fitness & Nutrition How often do you engage in physical activity, and what types of activities do you enjoy?
What fitness goals are you currently working toward, if any?
What challenges, if any, do you face in staying active or consistent with exercise?
What role does nutrition play in your life? Are there specific eating habits you’re proud of?
Do you have any dietary preferences, restrictions, or goals you’d like me to know about?
What does a balanced meal look like for you?
If you could improve one thing about your current fitness or nutrition routine, what would it be?
Drugs & Alcohol Do you currently use or have a history with drugs, including caffeine or alcohol?
If yes, how do you feel this may impact your health, wellness, or coaching journey?
Is there any additional information you're comfortable sharing so I can best support you?
Toxins & Clean Living Are there any toxins or chemicals you're mindful of reducing or avoiding in your daily life (e.g., household products, beauty products, cookware)?
What steps, if any, have you taken toward a cleaner living environment?
Are there specific areas where you’d like more guidance or support in minimizing toxins?
How do you feel your current lifestyle choices impact your overall health and wellness?
Screen Time & Media Consumption How much time do you spend watching television, movies, or engaging with social media on a typical day or week?
What type of content do you typically watch or read?
Your Wealth & Abundance How much time do you spend watching television, movies, or engaging with social media on a typical day or week?
What are your top financial goals right now?
What habits or practices do you currently have to manage your finances?
If you could improve one area of your financial life, what would it be?
How confident do you feel about making financial decisions, and what resources or support might help you feel more empowered?
What is your ultimate vision for wealth and abundance in your life?
Your Lifestyle & Aspirations Describe a typical day in your life. What are you proud of, and what would you like to improve?
What dreams or goals excite you the most right now?
If you could wave a magic wand, what would you change in your life today?
How do you currently manage stress and balance your responsibilities?
What would success in this coaching journey look like to you?
Your Why What inspired you to seek coaching at this time?
What is your biggest WHY, your motivation for making changes in your life?
How would you describe your ideal self one year from now?
How would you describe your ideal self five years from now?
Your Support System Do you feel supported in your goals by your spouse, partner, friends, family, or others? If yes, how? If no, what support do you wish you had?
How can I best support and empower you throughout this process?
Self-Reflection What do you love most about yourself?
What are you most grateful for in your life right now?
Thank You & Final Note Thank you for taking the time to be so open and honest in sharing your journey. Your willingness to be vulnerable allows me to better understand your needs and serve you in the most supportive and empowering way possible.
Please remember that everything you’ve shared is held in the strictest confidence, with zero judgment—only support, understanding, and encouragement as we work together to create the life you envision.
I’m honored to walk alongside you on this path. Let's do this, together!🔥
Yours in Health, Wealth & Abundance
Corrie
The Unregistered Nurse 🎀
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