TELL ME ABOUT YOURSELF
What time zone are you in?
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How did you hear about the Mind Body Rewire Program?
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If a person referred you, please type their name below
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Do you work at this time?
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Your Age
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What are your biggest struggles when trying to heal your symptoms?
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What symptoms/diagnosis are you seeking help for?
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How long have you had these symptoms?
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What kind of approaches have you tried to resolve these symptoms?
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How does having these symptoms and not finding the solution make you feel?
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If you could wave a magic wand when it comes to your health, what would your #1 desired outcome be in the next 6 months?
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What do YOU believe is the root cause to your symptoms?
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Have you ever worked with a coach or mentor before?
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What percent do you believe you are responsible for your healing?
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On a scale of 0-10, how willing are you to be uncomfortable for the sake of your healing?
- 10 being that you know shifting old patterns can be uncomfortable but understand that its necessary to heal and are willing to do it.
- 1 meaning you don't want to be uncomfortable and you're not willing to make any changes to create the result that you want.
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Are you willing to put your healing and the work that is required for your healing as a priority in your life? This means you will need to spend 30-60 minutes a day on your healing.
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Are you open to the idea that physical ailments have an emotional connection?
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What would be the length of time that you are willing to invest in your healing?
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What kind of solution are you looking for right now?
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The MBR Program includes a variety of tools to assist with healing including, meditation, yoga, and hypnosis. Are you ok with using these?
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What do YOU think is the biggest block getting in the way of your healing?
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What are the biggest reasons you're drawn to working with a coach versus healing on your own?
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Are you on any medications? If yes, which ones?
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Are you open to healing your symptoms without detoxing, diet restrictions or pills?
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Have you listened to Jenny's Podcast (Simplify Your Healing Podcast) and have a good idea of the type of work that Jenny and her team does?
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