Welcome, friend!

I'm SO excited to have you aboard, and I can't wait to get started on your healing adventure. I'm honored that you chose to work with me, and I look forward to all the ways that I may serve you powerfully along your journey.

You have likely received a link to this page, because we have already chatted a bit, and you've said "YES" to your own health and wellbeing. This form is meant to be your first official step in our coaching relationship, and this will give us a good idea of where to begin and what to focus on during our initial chats together.

Please take the time to fill this out as completely as you can. This will stay in my records, and will not be viewed by anyone but me!

For the self-assessment portion, I would like you to rate on a scale of 1-10, your current state of wellbeing for each of my 7 coaching themes. You may refer to them in more detail HERE. 1= absolutely dismal, very poor health in this area. 10= fantastic, totally working great!

Ready? Alright, let's roll. 


New Client Onboarding Form

Name *
Name
Phone
Phone
Please list all the prescription medications, OTC drugs, and nutritional supplements you are currently taking.
What of the following tools do you currently have access to? *
We may incorporate any/all of these during our work together!
What health professionals do you currently work with? *
Please rate your current state of wellbeing for the "root chakra" themes. Emotional/mental themes of stability, structure, security, and belonging. Physical: musculoskeletal system.
Feel free to expand on what is and isn't working in this area.
Please rate your current state of wellbeing for the "sacral chakra" themes. Emotional/mental themes of: sexuality, pleasure, creativity, intimacy. Physical: reproductive organs and pelvic bowl.
Feel free to expand on what is and isn't working in this area.
Please rate your current state of wellbeing for the "solar plexus chakra" themes. Emotional/mental themes of: joy, accomplishment, willpower, drive. Physical: digestive system.
Feel free to expand on what is and isn't working in this area.
Please rate your current state of wellbeing for the "heart chakra" themes. Emotional/mental themes of: compassion, relationships, vulnerability. Physical: cardiovascular system.
Feel free to expand on what is and isn't working in this area.
Please rate your current state of wellbeing for the "throat chakra" themes. Emotional/mental themes of: integrity, communication, advocacy. Physical: respiratory system.
Feel free to expand on what is and isn't working in this area.
Please rate your current state of wellbeing for the "third eye chakra" themes. Emotional/mental themes of: intuition, learning, wisdom, truth. Physical: brain and nervous system.
Feel free to expand on what is and isn't working in this area.
Please rate your current state of wellbeing for the "crown chakra" themes. Emotional/mental themes of: spiritual connection, alignment, resonance with higher self. Physical: whole body balance.
Feel free to expand on what is and isn't working in this area.
I typically use Zoom, which offers both audio-only and video conferencing options.
If we haven't already chosen a time for a standing weekly session, please give me some preferred days/times that will reliably be open each week
By typing your name into the box below, you understand that you are signing up for wellness coaching with me. You understand that I am not a doctor or a licensed mental health professional, and that my recommendations are not overseen nor approved by a governing body. My advice is not meant to take the place of medical or psychiatric care. You understand that coaching is a professional relationship, designed to supplement your relationships with your healthcare providers. You understand that you cannot hold liable myself, Melani Schweder, or my business, A Brighter Wild, for potential harm caused by your implementing my recommendations. You agree to honor your own body, respect your limits, and communicate any issues with me during our time working together.