Rooted Resilience Health Coaching

Questionnaire

Whether you’re navigating the demands of military life or simply ready to build a healthier, more resilient you — you’re in the right place. This questionnaire helps me understand where you’re starting from and where you want to go, so we can build a plan that actually fits your life — your schedule, your season, your goals. There are no right or wrong answers here. Just be honest, take your time, and know that everything you share is completely confidential. This is your space.

⏱ Takes about 8–12 minutes · 6 short sections

Name
Nickname, first name, callsign — whatever feels right to you.
Your information is kept private and will only be used to connect with you about your coaching experience.
A friend or family member referred me / Instagram / Facebook / Google search / Military community or resource / Other
The more specific, the better. “Lose weight” is a start — but “have consistent energy to keep up with my kids after a long duty day” tells me so much more.
Sometimes it’s a PCS that reset your routine. Sometimes it’s a deployment that changed you. Sometimes it’s just knowing you deserve to feel better. Whatever it is — I’d love to hear it.
Which areas of wellness are you most ready to focus on? (Select all that apply)
If Yes…Tell me about it. What worked well? What didn’t? What do you wish had been different?
Think about what a normal day looks like — not your best day or worst day. Do you skip meals? Rely on the DFAC or fast food? Stress eat? Eat well but then fall off on the weekends? All of it is useful to know.
On average, how many nights a week do you get 7 or more hours of sleep?
We know military schedules don’t always cooperate — just give me your honest average.
How would you describe your current activity level?
On a scale of 1–10, how would you rate your current stress levels?
1 = feeling calm and grounded · 10 = running on fumes and barely keeping it together
This might include things like thyroid issues, chronic pain, food allergies, service-connected injuries, or anything else that shapes how you feel day-to-day. Your response is completely confidential and helps me create a plan that’s safe and right for you.
Be real with me. Is it time? Energy? Motivation? A PCS that derailed your routine? Feeling like you always put everyone else first? There’s no wrong answer — this is where we start breaking through.
On a scale of 1–10, how ready and committed are you to making real changes right now?
1 = just exploring, not quite ready · 10 = I’m all in, let’s go · Wherever you are is okay — honesty helps me meet you where you are.
Paint the picture. How do you feel when you wake up? What can you do that you can’t do now? How do you show up for your family, your unit, or yourself? This is your vision — make it vivid.
Do you have people in your corner who will support you on this journey?
There’s no right answer. Whether you have a squad behind you or you’re flying solo, we’ll make it work.
What kind of coaching energy resonates most with you? (Select all that apply)
How do you prefer to stay connected between sessions?
I’ll follow your lead on this — you set the pace.
Realistically — given your schedule, your family, your duties — how many hours per week can you commit to your wellness goals outside of our sessions?
Honest answers here lead to a plan that’s actually achievable. Progress beats perfection every time.
This is your space. Maybe there’s a unique challenge that comes with your duty station, your family situation, or your season of life. Maybe there’s something you’ve been carrying that feels relevant. Whatever it is, I’m listening.
Consent & Confidentiality