CONTACT

Main Office

405 E Branch St Suite 112
Arroyo Grande, CA 93420

(805) 710-2513

STAY IN THE ZONE

© 2019 by Turning Leaves Recovery Life and Wellness Coaching LLC®

Proudly created with www.chance436ds.com

What is the biggest reason that you are exploring our program?
What is the most import change you for you to achieve?
What will it mean for you if it doesn't happen?
What are you willing to do to ensure it does happen?
Which service(s) are you feeling most drawn to?
In YOUR words tell me how you want to see yourself in your life. Include what you feel you are lacking, how you think you ended up stuck in this position, your ideas about what you want to change, and don't forget to tell me how much it would mean to you if you could make this transition your reality.

Please rate the intensity of your symptoms for this and the following 7 characteristics: 0…..1 (hardly noticeable)...2...3….4...5 (bearable)...6...7...8...9...10 (unmanageable)

Beginning with Anxiety:

Depression:

Irritability:

Impusivity:

Motivation:

Cravings for chemical substances:

Cravings for food items: