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Name
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Email
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What can we help you with? This will take 1-2 minutes to complete.
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I am looking for help with working out and/or improving my nutrition
I want tools that will help me reach my goals or change daily habits
I want help to feel less stressed and/or happier
I want assistance with building stronger relationships (including couple's counseling)
I am seeking EMDR or other trauma treatment assistance
I want to learn how to teach my child the tools they need to be happy and successful
I am contacting Onestep related to something else
Choose your top 1-3
Personal Training/Nutrition Coaching
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I'm ready to get stronger
I want to lose weight
I want a manageable workout routine
I'm ready to change my eating habits
I am interested in being more flexible and/or reducing pain
I want self-defense training
I am willing to track my food intake for three days as a part of a nutrition assessment:
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Yes
No, thanks, I'll hold off on a nutrition plan for now
Goals/Making Changes
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I set goals, but frequently struggle to reach them
I am looking to be more organized, focused, etc.
I need help keeping myself motivated
I want to work with a coach to further explore my goals
I want a daily routine that helps me feel good
I want to learn how to make new habits that stick
Relationships
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My significant other and I are struggling
We are seeking couple's counseling to strengthen our relationship
I want help individually to be a better partner
I get anxious in social situations
I need help setting/maintaining healthy boundaries
I want to have healthier relationships
Stress Reduction/Anxiety/Resilience
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I often feel stress
I'm tired of feeling blah
I notice my mood worsens around the same time each year
I usually feel good, but when triggered, I struggle
I want to explore further what makes me happy
I am frequently anxious
I am willing to work on my diet/exercise to improve my mood
More information related to improving relationship(s):
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I/we struggle to communicate our feelings/needs
I/we struggle to manage conflict
We want to strengthen our romantic/emotional connection
We want to increase intimacy in our relationship
Something happened that damaged trust in our relationship
Stress is impacting the health of our relationship
Trauma Care
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I am dealing with challenges as a result of a traumatic experience
I am a first responder or veteran
My partner and I both need assistance related to a trauma
I specifically am seeking EMDR treatment
Additional information related to trauma:
I have had an experience where I felt I was at risk of severe injury/death
I have experienced sexual assault
Someone close to me has experienced violence or accident that resulted in severe injury/death
I have received trauma treatment in the past
I have experienced trauma related to my work
How old are your child(ren)?
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Message
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I'd like to receive your newsletter:
Yes, please
No, thanks
Mostly just physical wellness information, thanks
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