{"id":1168,"date":"2017-10-10T13:35:24","date_gmt":"2017-10-10T17:35:24","guid":{"rendered":"http:\/\/ouwebs-project-3.pro\/?page_id=1168"},"modified":"2018-06-19T23:18:32","modified_gmt":"2018-06-20T05:18:32","slug":"complimentary-wellness-coaching-session","status":"publish","type":"page","link":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/","title":{"rendered":"Complimentary Wellness Coaching Session Pre-Survey"},"content":{"rendered":"<p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css=&#8221;.vc_custom_1507673587566{padding-top: 0px !important;}&#8221;][vc_column][vc_column_text]<\/p>\n<p><strong>Please complete this brief stress and wellness survey to receive a complimentary coaching session.<\/strong>\u00a0 All information is retained as strictly confidential according to provisions of the HIPAA (The Health Insurance Portability and Accountability Act of 1996) Privacy Rule, which protects the privacy of individually identifiable health information.\u00a0 We also invite you to review our Privacy Statement, found at the bottom of our home page.[\/vc_column_text][\/vc_column][\/vc_row][vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221;][vc_column][vc_column_text]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1169-o1\" lang=\"en-CA\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/1168#wpcf7-f1169-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1169\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_CA\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1169-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div id=\"survey-stress\">\n\t<p><label>First Name *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label>Last Name *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-last\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-last\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label>Email *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label>Phone No.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span> <\/label>\n\t<\/p>\n\t<p><label>When is the best time to reach you? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-time\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-time\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<p id=\"hearus\"><br \/>\nHow did you hear about us? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-hear\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Community event\" \/><span class=\"wpcf7-list-item-label\">Community event<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Word of mouth\" \/><span class=\"wpcf7-list-item-label\">Word of mouth<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Sweet Livity team member\" \/><span class=\"wpcf7-list-item-label\">Sweet Livity team member<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Sweet Livity marketing material\" \/><span class=\"wpcf7-list-item-label\">Sweet Livity marketing material<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Sweet Livity workshop or training\" \/><span class=\"wpcf7-list-item-label\">Sweet Livity workshop or training<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Sweet Livity client\" \/><span class=\"wpcf7-list-item-label\">Sweet Livity client<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Search engine\" \/><span class=\"wpcf7-list-item-label\">Search engine<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Facebook\" \/><span class=\"wpcf7-list-item-label\">Facebook<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"LinkedIn\" \/><span class=\"wpcf7-list-item-label\">LinkedIn<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Article\" \/><span class=\"wpcf7-list-item-label\">Article<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Health Provider\" \/><span class=\"wpcf7-list-item-label\">Health Provider<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"your-hear[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>If Other, please describe below:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-other\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-other\" \/><\/span> <\/label>\n<\/p>\n<h2>Stress Survey\n<\/h2>\n<p>Do you feel stress in your life or work?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-stress\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-stress\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-stress\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Do you have any of the following responses to stress?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-responses\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"your-responses[]\" value=\"Unhealthy eating habits\" \/><span class=\"wpcf7-list-item-label\">Unhealthy eating habits<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-responses[]\" value=\"Hiding \/ withdrawing\" \/><span class=\"wpcf7-list-item-label\">Hiding \/ withdrawing<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-responses[]\" value=\"Tenseness in your relationships\" \/><span class=\"wpcf7-list-item-label\">Tenseness in your relationships<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-responses[]\" value=\"Working too much\" \/><span class=\"wpcf7-list-item-label\">Working too much<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"your-responses[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>If Other, please describe below:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-other2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-other2\" \/><\/span> <\/label>\n<\/p>\n<p><label>What do you do to relieve stress?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-relieve\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-relieve\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>What are the three biggest sources of stress in your life?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-sources\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-sources\"><\/textarea><\/span><\/label>\n<\/p>\n<p>How often do you practice holistic health (massage, acupuncture, meditation, etc.)?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-practice\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-practice\" value=\"Have not tried yet\" \/><span class=\"wpcf7-list-item-label\">Have not tried yet<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"your-practice\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"your-practice\" value=\"A few times a year\" \/><span class=\"wpcf7-list-item-label\">A few times a year<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"your-practice\" value=\"monthly\" \/><span class=\"wpcf7-list-item-label\">monthly<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"your-practice\" value=\"weekly\" \/><span class=\"wpcf7-list-item-label\">weekly<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-practice\" value=\"daily\" \/><span class=\"wpcf7-list-item-label\">daily<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Would you like Sweet Livity to contact you for a complimentary consultation?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-complimentary\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-complimentary\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-complimentary\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>What do you want from a session with Sweet Livity?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-session\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-session\"><\/textarea><\/span><\/label>\n<\/p>\n<div id=\"cf7sr-6616fa82282b9\" class=\"cf7sr-g-recaptcha\" data-theme=\"light\" data-type=\"image\" data-size=\"normal\" data-sitekey=\"6LfPb5UUAAAAAFu8cH6aTWHoR9hOjfhcZYRkFxgz\"><\/div><span class=\"wpcf7-form-control-wrap cf7sr-recaptcha\" data-name=\"cf7sr-recaptcha\"><input type=\"hidden\" name=\"cf7sr-recaptcha\" value=\"\" class=\"wpcf7-form-control\"><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css=&#8221;.vc_custom_1507673587566{padding-top: 0px !important;}&#8221;][vc_column][vc_column_text] Please complete this brief stress and wellness survey to receive a complimentary coaching session.\u00a0 All information is retained as strictly confidential according to provisions of the HIPAA (The Health Insurance Portability and Accountability Act&#8230;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Complimentary Wellness Coaching Session Pre-Survey - Sweet Livity LLC<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Complimentary Wellness Coaching Session Pre-Survey - Sweet Livity LLC\" \/>\n<meta property=\"og:description\" content=\"[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css=&#8221;.vc_custom_1507673587566{padding-top: 0px !important;}&#8221;][vc_column][vc_column_text] Please complete this brief stress and wellness survey to receive a complimentary coaching session.\u00a0 All information is retained as strictly confidential according to provisions of the HIPAA (The Health Insurance Portability and Accountability Act...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/\" \/>\n<meta property=\"og:site_name\" content=\"Sweet Livity LLC\" \/>\n<meta property=\"article:modified_time\" content=\"2018-06-20T05:18:32+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/\",\"url\":\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/\",\"name\":\"Complimentary Wellness Coaching Session Pre-Survey - Sweet Livity LLC\",\"isPartOf\":{\"@id\":\"https:\/\/sweetlivity.com\/#website\"},\"datePublished\":\"2017-10-10T17:35:24+00:00\",\"dateModified\":\"2018-06-20T05:18:32+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/sweetlivity.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Complimentary Wellness Coaching Session Pre-Survey\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/sweetlivity.com\/#website\",\"url\":\"https:\/\/sweetlivity.com\/\",\"name\":\"Sweet Livity LLC\",\"description\":\"Sweet Livity LLC | Sustaining the well-being of individuals\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/sweetlivity.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Complimentary Wellness Coaching Session Pre-Survey - Sweet Livity LLC","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/","og_locale":"en_US","og_type":"article","og_title":"Complimentary Wellness Coaching Session Pre-Survey - Sweet Livity LLC","og_description":"[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; css=&#8221;.vc_custom_1507673587566{padding-top: 0px !important;}&#8221;][vc_column][vc_column_text] Please complete this brief stress and wellness survey to receive a complimentary coaching session.\u00a0 All information is retained as strictly confidential according to provisions of the HIPAA (The Health Insurance Portability and Accountability Act...","og_url":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/","og_site_name":"Sweet Livity LLC","article_modified_time":"2018-06-20T05:18:32+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/","url":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/","name":"Complimentary Wellness Coaching Session Pre-Survey - Sweet Livity LLC","isPartOf":{"@id":"https:\/\/sweetlivity.com\/#website"},"datePublished":"2017-10-10T17:35:24+00:00","dateModified":"2018-06-20T05:18:32+00:00","breadcrumb":{"@id":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/sweetlivity.com\/complimentary-wellness-coaching-session\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/sweetlivity.com\/"},{"@type":"ListItem","position":2,"name":"Complimentary Wellness Coaching Session Pre-Survey"}]},{"@type":"WebSite","@id":"https:\/\/sweetlivity.com\/#website","url":"https:\/\/sweetlivity.com\/","name":"Sweet Livity LLC","description":"Sweet Livity LLC | Sustaining the well-being of individuals","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/sweetlivity.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/pages\/1168"}],"collection":[{"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/comments?post=1168"}],"version-history":[{"count":13,"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/pages\/1168\/revisions"}],"predecessor-version":[{"id":2025,"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/pages\/1168\/revisions\/2025"}],"wp:attachment":[{"href":"https:\/\/sweetlivity.com\/wp-json\/wp\/v2\/media?parent=1168"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}