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Welcome to the Body & Mind Balance Intake Questionnaire

Thank you for taking the time to fill out this form.

This is the first and most important step in your personal transformation journey.

The purpose of this questionnaire is to help me, as your coach and mentor, understand your current condition, needs, goals, habits and mindset – so I can design a highly personalized and effective program that aligns with your vision of a healthy, fulfilling and balanced life.

Please answer each question honestly and thoroughly. Your responses will remain confidential and will be used solely for the purpose of optimizing our collaboration.

Let’s begin the process of building your best self – physically, mentally, and emotionally.

– Filip Olšavský

Founder of Body & Mind Balance

Zabezpečené

SECTION 1: Personal Information

1

Full name:

2

Date of birth:

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3

Email address:

4

Phone number:

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