Health Coaching Web Form

Our 12 week one-to-one Health Coaching empowers you to make lifestyle changes that are tailored to your needs. With personalised guidance from one of our expert Health Coaches through our dedicated app we will help keep you motivated by not only tracking your progress but also by supporting you to take steps towards better health.

^{All the information we collect is private and confidential. No personal or sensitive information will be shared onwards unless there is a legal requirement to do so or a serious risk of harm to yourself or others. Data collected may be used for analytical purposes and will be made anonymous in line with our privacy policy https://www.axahealth.co.uk/healthservicesprivacypolicy}

All fields are required.

Full Name

Email

Phone Number

1. What area(s) of your health or lifestyle would you like to improve? Exercise Nutrition Sleep Weight management Work-life balance Health risk (blood pressure, cholesterol, blood glucose) Other

What other areas did you have in mind?

2. On a scale of 0 to 10 (0 being not important at all and 10 being extremely important), how important is it for you to make improvements to your health and lifestyle? 0 10

3. What are the main reasons you scored question 2 at that level?

4. On a scale of 0 to 10 (0 being not prepared to change and 10 being already changing), how ready are you to make improvements to your health and lifestyle? 0 10

5. What are the main reasons you scored question 4 at that level?

6. What would you like to get out of the Health Coaching support? I want more information on specific ways to improve my health Support with motivation General information Getting around barriers I want 1:1 support Other

What other things would you like to get out of Health Coaching support?