HANSENFIVE Email Marketing -

Questionnaire

Physical wellness includes aspects of diet/nutrition, exercise, sleep and stress but you are not just a body, you are also a mind and soul and your mental, emotional, spiritual, relational and financial wellness are ALL part of the whole that makes up your best life.

In a couple sentences, describe the most beautiful vision you have for your health & well-being: *

What actions have you taken to try to resolve this issue? Check all that apply.*

I have seen my healthcare provider regarding this issue

I have taken a course/ participated in a workshop

I have invested in 1:1 personal coaching

I have worked on resolving this issue on my own

This application is my first step in seeking help!

What was the result of these actions?*

What do you feel is the biggest challenge holding you back from bringing this vision into reality?*

Why do you desire to fulfill on this vision? What will be possible for you when you make this vision a reality? *

Mid-life tends to bring a vivid realization that the second half of life could be different. Sometimes this is accompanied by a sense of urgency that you need to shake things up, shift priorities, deepen into personal fulfillment and experience more joy. Do any of these common challenges resonate for you? *Pick only 1

Managing menopausal symptoms and finding deeper meaning, purpose and passion in the second half of your life.

Re-igniting the passion in your intimate partner relationship while having all your physical and emotional needs met by rediscovering your radical self-confidence.

Establishing a truly nurturing personal wellness routine for body, mind and soul so that your inner and outer life align; guiding you to a healthy, vital, awakened and fulfilled life.

How did you learn about Dr.Hansen or The Empowered Women's Circle?*

Full Name*

Email*

Phone*