Concerige Health/Mindset Strategy Session - ConnectMD

Book your 30 Minute Connect Call with Seku Gathers M.D. now.

Duration: 30 minutes
Name: *
Email: *
The purpose of this worksheet is to allow me to know you better and understand your health and success goals.  First read all of the questions below, then answer from top to bottom spending more than 2 minutes on each.


What are you working on right now that might benefit from mindset coaching?

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What would you like to have happen in that area?

{"type":"textarea","name":"whyCoachingWouldLike","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please indicate what you're looking to have happen.","height":80,"placeholder":"Here, too, is a great place to get DETAILED."}

How do you think being coached might help you to realize that aim?

{"type":"textarea","name":"whyCoachingHowHelpful","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"One place to look: how do you personally like to be supported? What benefits do you get?"}

How would you rate your commitment to having our work make a difference for you?

{"type":"radio","name":"whyCoachingCommitment","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please indicate your commitment level.","options":"I'm just gonna sit back while you fix me.\nWe'll see how it goes.\nI'll do the work, and hope for the best.\nI'm gonna play my heart out, coach!"}

What's one tangible thing that you can measure over time towards that aim?

{"type":"text","name":"whyCoachingToMeasure","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please share something meaningful we might track.","placeholder":"Some number you could track, perhaps on a weekly or monthly basis?"}

Now please take a minute to create one Metric and two Actions based on your answers to the last two questions.  I look forward to working with you on this!




How would you rate your overall health from 1-10. Describe why?  

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If you take medications or vitamins please list them here. Doses are not necessary. 

{"type":"textarea","name":"preSessionExcited","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item, even if it's just typing in \"Nada\". :)","height":80,"placeholder":""}

Is there a particular part your health that concerns you? What have you done (testing/specialist) in the past to address this issue?    

{"type":"textarea","name":"__generic","width":100,"value":"","size":"Large","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

What percentage of the time is your energy high?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"100%\n75%\n50%\n25%"}

Do you regularly practice any mindfulness techniques (Meditation, Journaling, Yoga)? 

{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}

If so, which one (s)?
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