6D Health & Lifestyle Coaching

Client Information

Please complete this form before your first consultation with a 6D Living Health & Lifestyle Coach. Please be as thorough as possible when providing information about your current health and lifestyle reality. All information is confidential; only 6D Health & Lifestyle coaches will have access to this information and it will never be shared publicly in any way.

First name

Last name

Birthday

Month

Day

Year

What are some of your hobbies and joys in your life?

Do you currently have any diagnosed medical conditions or health issues? Please be specific and include diagnosis dates when possible, thank you

Are you currently taking any prescription medications, supplements homeopathic remedies or internal essential oils? If yes, please list them below, including how often your take it and the dosage level, thank you.

Please describe your typical breakfast and what time you eat - generally.

Please describe your typical lunch and what time you eat - generally.

Please describe your typical dinner and what time you eat - generally.

How often do you meditate and what type of meditation do you practice?

How often do you exercise or move your body? What is your preferred type of exercise or movement?

When was the last time you consumed any animal or dairy products (including eggs) and what was it?

Thank you for answering these questions. Please know that everything you have shared and everything discussed in your private consultations is confidential and will only be viewed by 6D Health & Lifestyle Coaches.

By submitting this Client Information form, you agree to work with 6D Living Health & Lifestyle Coaches voluntarily and responsibly. You undertake this experience with the knowledge that you are in control of your choices and should you choose to apply any suggestions to your life, whether written or verbal, you will be responsible for the results. You accept that only you have the ability to choose your actions and you accept that you have the power to change your life.

I have read the Terms & Conditions and agree to abide by them.

I agree that all information provided by 6D Living Health & Lifestyle coaches is not intended as medical advice and should not be used as such

I agree that 6D Living Health & Lifestyle coaches cannot diagnose or prescribe medications, treatment, or testing procedures