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Before your consultation

Your health story

Health coaching: $250 monthly

Help Sheena get to know your health situation, goals, and everyday life before you meet. Share what feels relevant and comfortable for you.

This is your coaching consultation form. It is separate from the Youngevity product quiz.

A little context before we talk.

Only your name, email, and consent to send are required. You may leave other questions blank. Your answers stay on this page until you submit; drafts are not saved if you close or reload it.

Completed forms are sent to Sheena by email through FormSubmit. This form does not book an appointment and is not monitored for urgent medical concerns. Sheena will respond promptly via email to set up your consultation.

01Personal information
02Health and wellness goals
03Health history
04Physical health information

Include units, such as lb or kg.

Include units, such as feet/inches or cm.

How is your energy level most days?

1 = Very low · 5 = Very high. Select one, or leave blank.

Do you have any of the following concerns?

Metabolic health

Check all that apply.

Digestive health

Check all that apply.

Hormone health

Check all that apply.

Immune health

Check all that apply.

Brain health

Check all that apply.

05Nutrition information
Do any of the following apply to you?

Check all that apply.

Do you regularly use any of the following?

Check all that apply.

What does a typical day of eating look like for you?

Please include drinks.

06Mental health information
07Spiritual health information (optional)
08Lifestyle information
09Additional comments

Send your health story to Sheena

Review your answers before sending. FormSubmit processes this form and emails it to Sheena; FormSubmit states that it retains submissions for 30 days. A printable PDF of your answers is prepared with your submission and sent to Sheena as an email attachment.

Read the website privacy information · FormSubmit privacy policy (PDF)

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