Connect the Dots™ Wellness Coaching

Your Wellness Intake Form

Thank you for scheduling your Connect the Dots™ Wellness Consultation. Before we meet, share a bit of your story so I can arrive prepared, listen well, and make the most of our time together.

Before We Meet

A Thoughtful First Step

This form gives me a chance to listen carefully before our first conversation. Your answers help me notice patterns, prepare thoughtful questions, and honor your time. Answer what feels comfortable. There are no right or wrong responses — only your story.

Listen

Your story matters. I begin by truly hearing it.

Observe

Together we notice patterns others often overlook.

Connect

We organize the pieces into a clear, practical plan.

What to Expect

A Few Gentle Reminders

  • ✶ Take your time. This form is a conversation starter, not a test.
  • ✶ Skip anything that doesn't apply. We can explore more together during our session.
  • ✶ Your responses stay private. This information is used only to prepare for our work together.
  • ✶ Bring your curiosity. The best insights often begin with small observations.
Your Intake Form

Share Your Story

Please complete the questions below. When finished, I'll review your responses before our first session so we can begin right where you are.

Preferred Name (if different)
What inspired you to schedule this consultation today?*
What are your top three wellness goals?*
If our work together goes exactly as you hope, what would your life look like six months from now?*
Your Current Concerns
Which areas would you like to improve?*
Which concern affects your daily life the most?*
When did you first begin noticing these concerns?
Have your symptoms or concerns changed over time?
What have you already tried?
What helped, even a little?
What didn't work?
Have you noticed anything that seems to make your symptoms better or worse?
Tell me about a typical day.
How would you describe your current stress level?*
How many hours of sleep do you usually get?*
How would you describe your energy?*
Current Wellness Support
Please list any medications, supplements, or wellness products you currently use.
Do you currently work with any healthcare professionals?
Have you completed any recent lab work that you'd like to discuss?
How do you learn best?
How ready do you feel to make small lifestyle changes?*
Looking back, what patterns or connections have you noticed about your health that make you wonder, "There must be a connection"?
What questions do you hope I can help you answer?
What strengths do you already bring to your wellness journey?
When in your life did you feel your healthiest, and what was different then?
I understand this consultation provides wellness education and coaching. It does not diagnose, treat, or replace medical care from my healthcare provider.*
I understand meaningful wellness often develops through consistent daily habits rather than quick fixes.*
A Personal Note

Thank You for Trusting Me With Your Story

Meaningful wellness rarely comes from one quick fix. It grows through small, consistent steps and thoughtful observation. I look forward to walking alongside you, asking better questions, and helping you connect the dots.

See you soon,
Dr. Lynne Wimmer, DVM

Questions? Email Dr. Lynne