Health History | Goji Fitness
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Health History

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Personal Information

Birth Date
Please enter a number from 18 to 110.
Phone - please use country code if outside the US +1 (xxxx) xxx-xxxx
Preferred Contact Method:*

Health and Wellness Goals

Personal Health and Family History

Do you have any of the following? If so, please list.
Describe the health of your:

Physical Health Information

How is your energy level most days?
Metabolic health
Digestive health
Reproductive health
Hormonal health
Immune health
Brain health

Nutrition Information

Do any specific memories about food or eating come to mind?
Do any of the following apply to you? (Check all that apply.)
Do you regularly use any of the following? (Check all that apply.)

Mental and Emotional Health Information

Please enter a number from 1 to 5.
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Please enter a number from 1 to 5.
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Spiritual Health Information

Lifestyle Information

Addtional Comments

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

Personal Information

Birth Date
Please enter a number from 18 to 110.
Phone - please use country code if outside the US +1 (xxxx) xxx-xxxx
Preferred Contact Method:*

Health and Wellness Goals

Personal Health and Family History

Do you have any of the following? If so, please list.
Describe the health of your:

Physical Health Information

How is your energy level most days?
Metabolic health
Digestive health
Reproductive health
Hormonal health
Immune health
Brain health

Nutrition Information

Do any specific memories about food or eating come to mind?
Do any of the following apply to you? (Check all that apply.)
Do you regularly use any of the following? (Check all that apply.)

Mental and Emotional Health Information

Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.
Please enter a number from 1 to 5.

Spiritual Health Information

Lifestyle Information

Addtional Comments

This field is for validation purposes and should be left unchanged.

Goji Fitness LLC

Health, fitness and nutrition coaching company with an emphasis on bio-individuality.

We're in the business of inspiring transformation in our clientele. We believe that our clients can heal themselves by themselves and have all it takes inside of them (wisdom, intuition, courage, innate knowledge of what works for them) to create the health and life of their dreams. Our coaching focuses on guiding our clients to decipher their body's language, getting to the root cause beyond symptoms and helping them feel more confident to take consistent action.

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Courses & Services

We equip you with knowledge, tools and support to create bio-individual detox and get-to-know your own body experiences.

  • Live Class Schedule
  • On Demand Library
  • Tantric Date Night
  • Individual Coaching
  • Small Group Health Coaching Program
  • Personal Training
  • Feeding Succcess Book

Zenberry Mix

We also make the world's best-tasting superfood protein smoothie: Zenberry. Pick up some at Zenberrymix.com

Recent Recipes

  • Kichadi
    February 18, 2023
  • Decadent Chocolexir Smoothie
    February 13, 2023
  • Love Potion Smoothie
    February 2, 2023

Read More News and Recipes

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