Health Coaching Client Profile
This is a confidential form. All information provided will be held to HIPAA regulations in strictest confidence. It is most helpful to have this completed prior to your next session.
Thank you for your interest in choosing Coach Rebecca / Body Be Well Solutions to partner with you to improve your well-being through health coaching.
You may currently be under the care of a physician or a primary care treatment of a specific medical condition. It is important to understand the scope and the extent of services that Coach Rebecca will provide.
The information and any recommendations during your sessions are not intended to replace the advice of your qualified health care provider. Coach Rebecca recognizes that no one person is the same. Your health care provider should always be consulted before beginning any new exercise, supplementation, nutritional guidance or health plan.
This form is an opportunity for Coach Rebecca to gather some detailed information about you as an individual, your health and wellness status and history.
Please leave bank any information on this form that you are not comfortable providing. Filling out this form enables Coach Rebecca to best assess your goals, preferred coaching style, and client-focused needs.
We work to empower you to take control of your health and wellness by making Healthy a Habit, One Choice at a Time. We do this by partnering with you to increase self-awareness of choices while guiding you through the process of change.
