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Complimentary Wellness Coaching Session Pre-Survey

Please complete this brief stress and wellness survey to receive a complimentary coaching session.  All information is retained as strictly confidential according to provisions of the HIPAA (The Health Insurance Portability and Accountability Act of 1996) Privacy Rule, which protects the privacy of individually identifiable health information.  We also invite you to review our Privacy Statement, found at the bottom of our home page.


    How did you hear about us? *
    Community eventWord of mouthSweet Livity team memberSweet Livity marketing materialSweet Livity workshop or trainingSweet Livity clientSearch engineFacebookLinkedInArticleHealth ProviderOther

    Stress Survey

    Do you feel stress in your life or work?
    YesNo

    Do you have any of the following responses to stress?
    Unhealthy eating habitsHiding / withdrawingTenseness in your relationshipsWorking too muchOther

    How often do you practice holistic health (massage, acupuncture, meditation, etc.)?
    Have not tried yetNoA few times a yearmonthlyweeklydaily

    Would you like Sweet Livity to contact you for a complimentary consultation?
    YesNo