Skip to content

Jennings Holistic Health Coaching

New Zealand Health Coaching

Services
Our Book
Testimonials
In the Media
Our Story
Contact

Services
Our Book
Testimonials
In the Media
Our Story
Contact

Summer Survival Registration

Maintain Your Self Confidence and Bodyshape During the Silly Season

Please fill out your health questionnaire and pay using the Paypal button below.

Select your entry fee by using the drop down price menu.
Early bird new clients are $47 if you sign up before 5pm Thursday 24th December! Payments after this will be at full price of $97.00.
After your payment is successful, we will be sending out your program material before December 24. Please contact us if you have difficulty. Otherwise direct payment to our account : No Compromise Fitness Management LTD, Westpac 03 0435 0697863 00.
Please fill out your health questionnaire

Name *

First

Last

Email *

Phone *

Facebook Name

for video messenger chats

What Do You Need Help With Right Now? *

Bodyweight
Autoimmune Condition
Emotional Stress
Physical Pain
Gut Issue
Menopause
Depression/ Anxiety
Poor Sleep
Other

Have You Had or Currently Have Mercury Fillings? *

Yes
No

Are You a Previous Smoker? *

Yes
No

Do you work with chemicals such as pesticides & herbicides?

Stress

Please list what your biggest stress is right now ie work, relationships, kids etc

Historic Emotions

List any unresolved emotional stress here

Have you had surgery in the past?

If so, list here.

List any medications that you take

Bowel Movements *

Easy daily elimination like clockwork
Daily but irregular timing
Very irregular
Loose stools
Constipation

Family History

Please list any diseases that you are aware of with your family members

Grandparents

Blood Related Uncles & Aunties

Parents

Siblings

I accept that all data collected is strictly private. I understand that best to my knowledge I am submitting information that is true & correct. I understand the Steve Jennings holistic health Coach will provide dietary and other lifestyle instruction to aid me in my health objectives. I understand that results vary based on the individual. I understand that during a healing phase, it is normal to expect a “healing crisis,” where detox symptoms can appear initially. Steve Jennings Holistic Health Coach will not coach me on medication dosages such as anti depressants, anti anxiety medication and immuno suppressants. I will not hold Steve Jennings Holisitic health Coach responsible for accidental injury. *

I agree

Get in Touch

Start your journey with us today

Do you require an online consultation? Don’t hesitate to contact us today to set up a time.

Privacy Policy | Website designed by Digital Pie

© Jennings Health Coach. All rights reserved.