A FEW QUESTIONS BEFORE WE GET STARTED

Just considering a big change in your life and being mindful enough to realise that a shift requires action is a huge step, so congratulations on getting this far. To help make the process as efficient as possible, please complete the form below and I'll get back to you to as soon as possible to arrange our call.

Name

First Name

Last Name

Email Address

What are you passionate about achieving through Causeway Living?

A motivation or goal to check your decisions, "does this action take me 1 step closer or 1 further away?"

Do you or have you in the past suffered any long term health conditions?

Either physical or mental, and please indicate the timespan that you have dealt with the condition(s).

Are you currently taking any prescribed medications?

If so, please make clear which conditions the drugs have been prescribed for and dosage.

Do you use any recreational drugs or self-medicate?

Please indicate approximate use and which drug(s) e.g. Alcohol, Cannabis, Nicotine, Painkillers etc.

What is your profession and how much time does it take from each day?

Include time taken travelling to and from work, plus any work you might do at home.

Please provide a short description of what you drink on an average day:

Please include approximate quantity of each beverage.

How many meals do you eat a day?

Total occasions; include 'snacks' as meals.

Please choose the option you feel best describes your diet:

If you are unsure, be modest in your response.

Please provide a short description of your night time routine on an average day:

Include at least 1hr before bed, what time you usually fall asleep and when you wake up in the morning.

Please provide details of any physical exercise you get in an average week:

Include any regular walking you may have to do, or physical exertion as part of your job.

Please choose the option you feel best describes your relationship with meditation:

If you unsure, please be modest in your response.

What days/times are generally good to arrange a call?

Weekdays/weekends, mornings/afternoons/evenings - I can be flexible to suit your schedule.

Anything else you'd like to add before we start?

Please include any useful information not covered above.

While you're waiting for a reply, why not check out some free health tips and read about other success stories in my journal?

Pre-Call Questionnaire

A FEW QUESTIONS BEFORE WE GET STARTED