30 Day Reset - Coaching Assessment

Welcome to the Zholistic Life 30-Day Reset Coaching Program.

This assessment is the first step in preparing for your coaching journey. The information you provide will help me understand your current lifestyle, challenges, and goals so that our coaching sessions can be focused, intentional, and tailored specifically to your needs.

The purpose of the 30-Day Reset is to help you establish a stronger foundation for your health and daily habits while bringing greater alignment to your life—mentally, physically, and spiritually.

Please answer each question as honestly and thoughtfully as possible. The more clarity you provide, the better I can guide you during our time together.

*All information is confidential and will only be used to guide your coaching sessions and support plan.

Section 1: Personal & Contact Information

First name

Last name

Birthday

Month

Day

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Preferred Method of Contact

Section 2: Your Story

1. In your own words, what brings you to Zholistic Life Coaching at this time?

2. What do you hope to achieve through this journey?

3. What have you tried before, and what worked or didn’t work?

4. Is there a Scripture, phrase, or personal motto that guides you right now?

Section 3: Health Background

Current Weight (lbs):

Goal Weight (lbs):

Height:

Waist Circumference (inches):

Recent Blood Pressure (if known):

Recent Blood Sugar (if known):

Recent Cholesterol/Lipid Panel (if known):

If you checked any of the above or selected “Other,” please share as much detail as you feel comfortable:

When were you diagnosed?
How does this condition affect your daily life?
Have you received treatment or made lifestyle changes related to this condition?
What would “better” look like for you in this area?

Are you currently taking prescription medications?

Yes

If yes, please list medications and what they are prescribed for.

Do you currently work with a doctor or healthcare professional?

Yes

Have you had blood work within the past 12 months?

Yes

Section 4: Nutrition & Eating Habits

Describe a typical day of eating:

Do you follow a particular eating style (plant-based, standard, keto, etc.)?

How often do you eat out or use convenience/fast foods?

Water intake (approx. per day)

Most common food cravings:

Food allergies/intolerances:

What do you feel is your biggest challenge with food?

Long answer

What is your relationship with food like? (comfort, fuel, social, discipline, etc.)

Section 5: Movement & Activity

Current exercise routine (type, frequency, duration):

Physical limitations or injuries:

Movement/exercise goals:

How do you feel about your current fitness level?

What would movement with purpose look like for you?

Are you currently under any physical restrictions from a doctor?

Yes

If yes, what are your restrictions?

Section 6: Lifestyle & Energy

Average hours of sleep/night:

Do you feel rested when you wake up?

Yes

Current energy levels (1 = very low, 10 = very high):

Stress level:

Low

Medium

High

Main sources of stress:

What changes would help you feel more energized and balanced?

Section 7: Spiritual Life & Renewal

Is faith part of your health journey?

Yes

Unsure

How often do you spend time in prayer, meditation, or Scripture?

Do you have a church or faith community?

Yes

How would you describe your current relationship with God?

Are there areas in your spiritual walk you’d like to strengthen through this journey?

Section 8: Zholistic Wellness Wheel

Rate yourself in each area:

Spiritual

Mental/Emotional

Physical Health

Relationships

Finances

Career/Calling

Environment (Home/Work/Community)

Which area feels strongest right now?

Which feels most in need of renewal?

Section 9: Supplements & Support

Are you currently taking supplements?

Yes

If yes, please list them:

Have you ever used natural supplements?

Yes

Which areas interest you most? (check all that apply)

Detox & Cleansing

Daily Vitality & Hormone Balance

Energy & Performance

Heart & Circulation Support

Are you open to incorporating Zholistic Life supplements into your plan?

Yes

Section 10: Coaching Relationship & Communication Preferences

Other (please explain):

What would make you feel most supported in our coaching relationship?

How can I best walk alongside you in this journey?

Section 11: Commitment & Vision

On a scale of 1–10, how committed are you to making lifestyle changes?

If you could look ahead 6 months, what would success look like for you?

What would it mean for you personally, spiritually, and physically to achieve this vision?

What obstacles could prevent you from following through with this program?

Section 12: Authorization & Agreement

By submitting this form, I acknowledge and agree to the following:

The information I have provided is true and complete to the best of my knowledge.
I understand that Zholistic Life Coaching provides educational and faith-based wellness guidance intended to support personal growth and holistic health, not to diagnose or treat any medical condition.
I recognize that the success of my coaching journey depends on my personal effort, consistency, and willingness to apply the tools and strategies shared during sessions.
I understand that Zholistic Life and its representatives are not medical doctors, therapists, or licensed mental health professionals, and that all recommendations are made to enhance overall wellness and spiritual alignment.
I consent to the secure collection and storage of my responses for the purpose of creating a customized coaching plan and for future progress tracking.
I understand that I should consult my physician before making significant dietary, exercise, or lifestyle changes.
I release Zholistic Life, its coaches, and affiliates from any liability arising from my voluntary participation in this coaching program.

By signing below, I confirm that I have read, understood, and agree to the terms above.

Signature

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Date

Month

Day

Year

What Happens Next

Once your assessment has been submitted and your coaching enrollment is complete, please allow 3–5 business days for your responses to be reviewed and your coaching plan to be prepared.

You will then be contacted with instructions to schedule your first coaching session, where we will:

• review your goals and priorities

• discuss your current lifestyle patterns

• begin establishing practical strategies for your 30-day reset

This preparation process allows me to ensure that your coaching experience is intentional, structured, and aligned with your personal goals.

One time Investment

$297