CONTACT DR. TRISH SCHNEIDER

LET'S WORK TOGETHER

First Name *

Last Name *

Email *

In a few words, what is the primary reason you would like your child to see Dr. Schneider?

What are you hoping to get out of working together?

If you could change 3 things about your/your child’s life what would they be?

1.
2.
3.

Is there anything you/your child struggle with or find difficult?

What's going to be the biggest challenge or obstacle to your/your child’s success?

What other personal development / coaching / therapy have you/your child done in the past?

Is there anything you'd like me to be aware of?

How committed are you right now to improving your/your child’s health?

Fully committed! 10/10!

Kinda - I'm still not sure I want to do this. 5/10

I don't want to join a health and wellness program. 0/10

Please indicate where you are financially and mentally in your ability to invest in health coaching and guidance to help you get healthy.

I have $2,000-$10,000 readily available and am ready to invest my/my child’s health so I can be guided hands-on in this process.

I don't have $2,000-$10,000, but will get creative so I can to get it (a business loan, supported by family/friend, push out a different investment you were thinking of doing (vacay, home project, etc)

I don't have $2,000-$10,000 to invest in my/my child’s health.

LET'S WORK TOGETHER

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