Meet Erika Fore, CHC
Quiz: Is Health Coaching for You?
Refer a Friend!
Ask a Health Coach
Healthy Restaurant Reviews
Juices & Teas
Sauces & Dressings
Tofu & Tempeh
Men’s Health History
Telephone - Home
Telephone - Cell
Preferred method of contact
Phone call - home
Phone call - cell
Date of birth
Place of birth
Weight six months ago
Weight one year ago
Would you like your weight to be different?
If so, what?
Hours of work per week
Please list your main health concerns
Other concerns and/or goals?
At what point in your life did you feel best?
Any serious illnesses/hospitalizations/injuries?
How is/was the health of your mother?
How is/was the health of your father?
What is your ancestry?
What blood type are you?
Do you sleep well?
How many hours?
Do you wake up at night?
If so, why?
Any pain, stiffness or swelling?
Constipation/Diarrhea/Gas? Please explain
Allergies or sensitivities? Please explain
Do you take any supplements or medications? Please list
Any healers, helpers or therapies with which you are involved? Please list
What role does sports and exercise play in your life?
What foods did you eat often as a child?
What’s your food like these days?
Will family and/or friends be supportive of your desire to make food and/or lifestyle changes?
What percentage of your food is home cooked?
Do you cook?
Where do you get the rest from?
Do you crave sugar, coffee, cigarettes, or have any major addictions?
The most important thing I should change about my diet to improve my health is
Anything else you want to share?
Request Your Free Consultation