Client Intake — Naturlchmy

Naturlchmy

Client Intake — Internal

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Naturlchmy Discovery Call Intake

01 — Client Info

Full name

Email

Age

Gender / pronouns

Location / timezone

02 — Health Baseline

Primary symptoms (select all that apply)

Fatigue Bloating Brain fog Skin issues Weight gain Constipation Inflammation Hormonal imbalance Anxiety / mood Joint pain Poor sleep Low immunity

Other symptoms not listed

How long have these symptoms been present?

Less than 6 months 6–12 months 1–3 years 3+ years

Diagnosed conditions (if any)

Current medications / supplements

Energy level (1 = depleted, 10 = thriving)

Digestive health (1 = very poor, 10 = excellent)

03 — Diet & Lifestyle

Current diet style

Standard Vegetarian Vegan Keto Gluten-free Paleo Other

Alcohol consumption

None Occasional Weekly Daily

Water intake daily

< 4 cups 4–8 cups 8+ cups

Exercise frequency

Rarely 1–2x/week 3–4x/week Daily

Stress level (1 = calm, 10 = overwhelmed)

Sleep quality (1 = poor, 10 = excellent)

Any food sensitivities, allergies, or strong dislikes?

04 — Goals & Readiness

Primary goal from this work

Feel clean & clear Lose weight Clear skin Fix digestion More energy Hormone balance Mental clarity Long-term change

Why now? What made them reach out today?

Have they tried detoxing or cleansing before?

No, first time Yes, DIY Yes, with coach

Readiness to start (1 = just browsing, 10 = ready now)

What's their biggest block or hesitation right now?

05 — Investment & Fit

Comfortable investment range

Under $500 $500–$1k $1k–$2.5k $2,500+ Not a factor

Decision timeline

Ready today This week Next few weeks Just exploring

Decision-maker?

Yes, I decide alone Need to discuss

Recommended program fit

The Reset ($397) The Purge ($897) Alchemy Container ($2,400)

Coach notes (objections, vibe, anything notable)

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