Consultation Assessment Form

Thank you for choosing SLB! We’re thrilled you’re taking a step towards a healthier and happier you. This consultation will help us tailor a personalized wellness plan that fits your unique goals and needs.

Tell us about yourself:

Overall Wellness Goals

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Name

First

Last

Phone Number

What are your overall wellness goals? (e.g., increased flexibility, stress reduction, weight loss, self-defense skills)

Do you have any existing injuries or limitations we should be aware of?

How much time are you realistically able to commit to your wellness plan each week?

Briefly describe your current level of physical fitness (beginner, intermediate, advanced).

What are your top 3 overall wellness goals (e.g., increase flexibility, reduce stress, lose weight, gain muscle)?

Exploring Our Services. Mark all that interest you.

Yoga: We offer a variety of yoga styles, from gentle and restorative to more physically demanding Vinyasa flows. Let us know what kind of practice you’re interested in, whether it’s for relaxation, building strength, or improving flexibility.
Martial Arts: Are you interested in learning self-defense techniques, building confidence, or getting a challenging workout? We offer classes in various martial arts disciplines, such as [list some offered martial arts].
Personal Training: Our certified trainers can design a personalized fitness program to help you reach your specific goals, whether it’s building muscle, losing weight, or improving cardiovascular health.
Massage Therapy: Massage can help relieve muscle tension, improve circulation, and promote relaxation. We offer a variety of massage techniques, such as deep tissue, Swedish, and sports massage.
Reiki: Reiki is a form of energy healing that promotes relaxation and stress reduction.
Kickboxing: Kickboxing is a high-energy workout that combines punching and kicking techniques. It’s a great way to burn calories, improve coordination, and relieve stress.

Are there any specific classes or services you are interested in trying (e.g., yoga, kickboxing, massage)?

Have you practiced any of these activities before?

What is your experience level, if any?

How often do you currently exercise per week?

Describe your typical diet (e.g., healthy, processed foods, vegetarian).

How many hours of sleep do you get a night?

How would you describe your stress levels (low, moderate, high)?

What motivates you to reach your wellness goals?

What are your biggest challenges to staying consistent with exercise or healthy habits?

On a scale of 1-10 (10 being very committed), how committed are you to making positive changes in your life?

Comments or Questions

Building Your Plan:

Based on your goals, interests, and fitness level, we can recommend a combination of services to create a well-rounded wellness plan. We can also discuss class schedules, pricing packages, and answer any questions you may have.

Remember:

Your wellness journey is unique. We encourage you to try different services and find what works best for you.
Consistency is key! Aim for regular practice to see the most benefits.
Don’t hesitate to ask questions or let us know if you need modifications.

We are here to support you on your path to a healthier and happier you