Explore Your Health Form

Thank you for choosing to schedule a Health Support Connection Call with Jenny.

This a 2-step process:

  1. Complete this questionnaire as thoroughly as possible in order to make the most of our time together.
    • Any information provided will be treated confidentially.
    • Please submit the completed form at least 24 hours prior to our scheduled call time.

  2. Schedule your Explore Your Health Support Connection Call.


Many thanks


Why are you seeking health support at this time?


At this moment in time, how would you describe your level of well being, energy and self-care?

Have you been offered a conventional diagnosis and what symptoms are you experiencing?

Are you taking any prescribed or over the counter medications?

What abilities, passions and dreams are being curtailed by your challenges?

What are the three most challenging aspects of your life at present?

What kind of moments brings you joy and fulfillment?

Is there anything else you would like to share?

Please indicate below if you would like to meet via telephone or Skype.

Please indicate your telephone number or Skype username below:

Now that you have complete this questionnaire, please schedule your Explore Your Health Support Connection Call.

Click here to access my calendar.