Home
About Us
Conditions Treated
Anxiety Disorders
Attention Deficit Hyperactivity Disorder
Bipolar Mood Disorder
Depressive Disorders
Eating Disorders
Psychotic Disorders – Schizophrenia and Schizoaffective
Substance Use Disorders
Office Info
Office FAQ
Office Policy
Our Team
Photo Gallery
Providers
Services
NeuroStar Advanced TMS Therapy
Candidates
Conditions Treated
How It Works
Do NeuroStar Treatments Hurt?
Insurance Coverage
Counseling
Intensive Outpatient Program
Life & Health Coaching
Psychiatry
Resources
Blog
Advanced TMS Therapy FAQ
External Resources
Patient Forms
Test Your Mental Health
Depression Screening
Anxiety Screening
Alcohol Abuse Screening
Drug Abuse Screening
PTSD Screening
Mood Disorder Screening
Patient Portal
Give
Pay Bill
Contact Us
Call
(530) 889-8780
Home
About Us
Conditions Treated
Anxiety Disorders
Attention Deficit Hyperactivity Disorder
Bipolar Mood Disorder
Depressive Disorders
Eating Disorders
Psychotic Disorders – Schizophrenia and Schizoaffective
Substance Use Disorders
Office Info
Office FAQ
Office Policy
Our Team
Photo Gallery
Providers
Services
NeuroStar Advanced TMS Therapy
Candidates
Conditions Treated
How It Works
Do NeuroStar Treatments Hurt?
Insurance Coverage
Counseling
Intensive Outpatient Program
Life & Health Coaching
Psychiatry
Resources
Blog
Advanced TMS Therapy FAQ
External Resources
Patient Forms
Test Your Mental Health
Depression Screening
Anxiety Screening
Alcohol Abuse Screening
Drug Abuse Screening
PTSD Screening
Mood Disorder Screening
Patient Portal
Give
Pay Bill
Contact Us
Life and Health Coaching Questionnaire
Home
»
Life and Health Coaching Questionnaire
Life and Health Coaching Questionnaire
What are your primary reasons for seeking a coach?
would like someone to keep me accountable of my progress
would like to define new or re-define existing goal
other (please specify)
Have you gone through the IOP?
Yes
I would like to make changes on the following areas of my life:
Physical activity
Nutrition
Weight Management
Smoking cessation
Sleep hygiene
Stress management
Spiritual growth
Other (please specify)
In order of importance, what areas of your health would you like to start focusing more on?
Physical
Extremely Important
Very Important
Important
OK
Mental / Emotional
Extremely Important
Very Important
Important
OK
Social
Extremely Important
Very Important
Important
OK
Spiritual
Extremely Important
Very Important
Important
OK
Contact Policy*
By clicking “Submit”, you agree to Beautiful Minds Medical Terms of Use and Privacy Policy. You consent to receive phone calls and SMS messages from Beautiful Minds Medical for marketing purposes. Message frequency depends on usage activity. You may opt out from receiving these messages at any time. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
57868
Δ