The Presence Company™

Executive Wellness Intake

Welcome. Before our first session, I'd love to learn more about you so I can personalize every aspect of your wellness journey.

This assessment takes approximately 10–15 minutes
1

Personal Information

2

Physical Health

3

Medical History

4

Lifestyle

1 5 10
Very Low Very High
1 5 10
Exhausted Vibrant
5

Wellness Goals

6

Integrative Wellness Coaching

7

Wellness Preferences

8

Final Reflection

Your responses are confidential and will be stored securely.