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Worksheet

Life Boost Clarity Consult Form

I'm so glad we've connected! ❤️ A clarity call is a complimentary 1 hour coaching session to support you in connecting with why something has been feeling hard and what you can do to move forward in a way that feels like a weight is being lifted off your shoulders. 

You'll find that this consult form is very comprehensive. All aspects of your life influence your health and all aspects of your health impact your life - this is a way to take a holistic look so we can identify what you need to feel good inside and out.

I created this consult form to serve two purposes:

  1. It gives me a really good understanding of your background and challenges going into the call so that we can make the most of your time
  2. It will help you to start connecting with what you need and to understand why things have been feeling hard even before we chat

If any of the questions feel too hard or personal to answer - no prob! You don't have to answer anything you don't want to.

I want to put you at ease that this call is for you. You are not committing to anything by scheduling a call, and I will not be talking about any of my programs unless you specifically ask to discuss them. Sound good? 😊

Take your time with these questions, and don't hesitate to send me a message at amelia@lifeboost.today if you have any questions. I'm here for you and can't wait to connect further.

1. ➜

Name

2. ➜

Date

3. ➜

Email

4. ➜

Phone number

5. ➜

Which way of connecting works best for you?

6. ➜

Date of birth

7. ➜

Occupation

8. ➜

Relationship status

9. ➜

Do you have kids or pets?

10. ➜

What motivated you to schedule this call?

11. ➜

In what areas of your life are you feeling stuck, confused, or out of control?

12. ➜

What areas of your life are draining the most energy?

13. ➜

What areas of your life are boosting your energy or bringing you joy?

14. ➜

If you could take one thing off your plate, what would give you the biggest sense of relief?

15. ➜

What Wellness Level sounds most familiar to you? (Check all that apply)

If you're not familiar with them, you can read more about them here.

16. ➜

Are there any Life Boost principles you think you could benefit from leaning into or prioritizing more? Check all that apply.

You can read more about them here. 

17. ➜

Are there any Life Boost L's you haven't been prioritizing?

Love - You love what you’re doing, the way it’s making you feel, and your approach is loving and respectful to your body and mind.

Lifestyle - Your approach feels doable and fits in with your lifestyle. It makes your life easier, not harder.

Long-term - Your wellness approach feels sustainable and like something you want to keep up long-term.


18. ➜

Do you think any of the Life Boost B’s (Belly, Brain, or Blood Sugar) are out of balance for you?

Take the super quick assessments in my Life Boost Starter Kit as a guide. https://www.lifeboost.today/lifebooststarterkit

19. ➜

How would you describe your relationship with yourself? Is there anything you would like to be different?

20. ➜

How would you describe your relationship with your body? Is there anything you would like to be different?

21. ➜

On a scale of 1-10, how would you rate your overall stress level?

22. ➜

What do you do for stress management?

23. ➜

Have you tried my favorite 1-minute anti-anxiety tool (Faster EFT) for stress? If so, what did you think?

You can get it here along with 6 tips on how to use it.

24. ➜

On a scale of 1-10, how would you rate your overall happiness?

25. ➜

What do you do for self-care?

26. ➜

What do you do for fun?

27. ➜

How much sleep do you typically get?

28. ➜

Do you fall asleep quickly?

29. ➜

Do you wake up during the night?

30. ➜

Is it easy for you to wake up in the morning?

31. ➜

How would you rate your overall energy level on a scale of 1-10?

32. ➜

Is there a certain time of day when you feel most exhausted?

33. ➜

Do you suffer from brain fog or find it difficult to focus or concentrate?

34. ➜

Are you happy with your level of productivity most days? If not, what do you wish you could do that you're not?

35. ➜

What is your fitness routine like?

36. ➜

On a scale of 1-10 how satisfied are you with your current level of health?

37. ➜

Do you have any current medical conditions?

38. ➜

Do you experience any pain, stiffness, swelling, or tension in your body?

39. ➜

Do you have any allergies or sensitivities?

40. ➜

What medications or supplements do you take?

41. ➜

How would you describe your relationship with food?

42. ➜

Do you cook? What percentage of your food is home cooked?

43. ➜

When you're not home cooking, where and what do you tend to eat?

44. ➜

What do you typically eat for breakfast?

45. ➜

What do you typically eat for lunch?

46. ➜

What do you typically eat for dinner?

47. ➜

What do you drink during the day?

48. ➜

What snacks and desserts do you eat?

49. ➜

Do you skip meals or fast? If so, please describe.

50. ➜

Are you currently following any diet (keto, paleo, intermittent fasting, vegan, plant-based, etc.)? If so, for how long and do you enjoy it?

51. ➜

Do you crave sugar, coffee/caffeine, alcohol, cigarettes, or anything else?

52. ➜

Do you have any addictions?

53. ➜

Are there any basic necessities (water, nourishing food, rest, sunlight) that you have been treating like a luxury? If so, why?

54. ➜

How is judgment towards yourself, your circumstances, or others contributing to what's feeling challenging?

55. ➜

Which of these tendencies can you relate to? Check all that apply.

Positive Intelligence is an approach that identifies 10 different "saboteurs" or inner critics (basically thoughts/tendencies that contribute to negative emotions). You can read more about each and take a short quiz at https://www.positiveintelligence.com/saboteurs/ if you're interested.

56. ➜

Where in your life are you probably being way too hard on yourself?

57. ➜

What do you want to be different?

58. ➜

What do you want to stay the same?

59. ➜

In what ways could your money mindset be getting in the way of prioritizing what you need?

If you haven't already, check out my "Life Boost with Amelia" podcast Episode 6: Is Your Money Mindset Impacting Your Health?

60. ➜

Is there anything about your past you think is relevant to share?

61. ➜

At what point in your life did you feel your best? Tell me about it!

62. ➜

Tell me about your dreams! Where would you like to be in 6 months, 1 year, 5 years?

63. ➜

At the end of your life, what will help you to look back without regrets?

64. ➜

What is the next smallest step you can take to move towards your dreams?

65. ➜

What questions do you have?

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