Complimentary Consultation

Midlife Vision
Consultation Questionnaire

The purpose of this meeting is to assess the current challenges of your midlife experience, and clarify your vision for a joyful, healthy and creative midlife. We will also see if we are a good fit to work together to support your positive midlife experience. Thank you for your responses. Once I review this I will send you a scheduling link for your complimentary consult. – Anasuya

    Name*

    Phone Number*

    Email*

    To give me a general sense of how midlife is impacting your health, please check any symptoms that affect you.
    Mood - anxiety or depressionWeight gainPMS or heavy periodsHot flashes / night sweatsInsomniaFatigueConcentration or focusDigestive disturbances

    Other

    What are the top challenges or worries you are facing as a midlife woman?

    Tell me a little about your willingness to allocate some time, energy, and financial resources to creating change?

    Is there anything else you would like me to know about your health, your state of mind, or your hopes and dreams?

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