Lifestyle Counselling Booking Form

Lifestyle Counselling

Lifestyle counseling involves providing guidance and support to individuals to help them make positive changes in various aspects of their lives, such as physical activity, nutrition, stress management, sleep habits, and more.

How satisfied are you with your current lifestyle?

Very satisfied Somewhat satisfied Neutral Very Dissatisfied

Which aspect of your lifestyle do you believe needs the most improvement?

physical activity Nutrition stress management sleep habits

How do you incorporate self-care practices into your daily routine?

Regularly schedule time for self-care activities Occasionally engage in self-care activities Rarely prioritize self-care Unsure or not familiar with self-care practices

How many hours of sleep do you typically get per night?

Less than 5 hours 5-6 hours 7-8 hours More than 8 hours

How would you describe your current stress level?

Low Moderate High Very high

How often do you engage in stress-reducing activities such as meditation, yoga, or deep breathing exercises?

Daily Several times a week Occasionally Rarely or never

How do you cope with setbacks or challenges in your life?

Seek support from others Practice self-care activities Avoid thinking about it Engage in unhealthy behaviors

What strategies do you use to manage your time effectively?

Prioritizing tasks Setting specific goals and deadlines Delegating tasks when possible Procrastinating or avoiding tasks

How often do you engage in leisure activities that you enjoy?

Daily Several times a week Once a week Rarely or never

How would you rate your current level of social support?

Strong Moderate Weak I prefer to keep myself

How often do you engage in activities to promote mental well-being?

Daily Several times a week Occasionally Rarely or never

How often do you experience feelings of burnout or exhaustion due to work or other responsibilities?

Frequently Occasionally Rarely Never

How do you manage your finances and budget for expenses?

Well-organized with a clear budget plan Somewhat organized, but could improve budgeting skills Often struggle to manage finances effectively I don’t have a budget plan

Are you currently seeking to make any specific lifestyle changes?

Yes No

How confident are you in your ability to achieve your aspired lifestyle?

How important do you believe Lifestyle counseling is in helping individuals achieve their aspired lifestyle?

Not important at all Somewhat important Moderately important Very important Extremely important

What is your email address?

What is your phone number?

Please select which of our Lifestyle counsellors you would like to book a session with:

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