Client Health Assessment

The Client Health Assessment is a valuable tool designed to gather essential information about your current health and well-being. By completing this assessment, you provide me with important insights into your physical, mental, and emotional state. This information is crucial in tailoring our coaching approach to best support your unique needs and goals. The assessment covers areas such as medical history, lifestyle habits, stress levels, and any specific health concerns. It serves as a foundation for our coaching journey, allowing us to create a holistic and personalized plan to enhance your overall well-being and success. Your health and safety are of utmost importance, and this assessment helps ensure that we work together in a way that honors and supports your wellness.

Name *

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Email *

Do you have any known medical conditions or physical health issues? *

Have you recently undergone any surgical procedures or experienced significant health changes? *

Do you have any allergies or sensitivities to mushrooms or other substances? *

On a scale of 1 to 10, how would you rate your current stress levels

Selected Value: 0

Have you been diagnosed with any mental health disorders or experienced significant psychological distress in the past? *

Are you currently receiving mental health treatment or taking any psychiatric medications? *

Have you ever experienced a history of substance abuse or addiction? *

Are you currently taking any medications or supplements? *

Are there any contraindications or precautions related to your current medication regimen? *

Have you ever had a psychedelic experience before, including with mushrooms or other substances? *

Do you have a reliable support system in place, including friends, family, or mental health professionals? *

Can you identify a trusted person you can reach out to for support after the journey? *

Phone Number *

What are your intentions and expectations for the mushroom journey? *

Have you engaged in adequate research and education about mushrooms and psychedelic experiences? *

Acknowledgement

By entering your name below, you affirm your agreement with the aforementioned statement. *

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