Shanon Roberts
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Mighty Method Intake Form
By sharing where you currently are with your home, spiritual, nutritional and fitness lifestyle, Shanon is better able to discover your personal and unique support needs (prayer, food, fitness, etc.). Identifying your needs enables her to better support, encourage and edify you as you seek to orient yourself and arrive where you sense God is calling you. We are where we are, no one place is better than another, and there is no judgment towards any one part of our place on our unique journey. Be encouraged to honestly assess and share, trusting your information will remain
private
.
You & Your Home Life
*
Indicates required field
Name
*
First
Last
Email
*
Married Status
*
Single
Married
Divorced
Widowed
Children?
*
Yes
No
Number of Children & Ages
*
Working Status
*
Unemployed
Self-employed
Employed Outside the Home Part-time
Employed Outside the Home Full-time
Time
The commitment will require an investment of both time and energy. Not only for those facilitating, but for those participating. Be encouraged to take an honest assessment of current time commitments. Are you ready to commit to and possibly rearrange priorities, to ensure fare amount of time be given to the ten week commitment?
I'm ready to commit my time:
*
Yes
No
Let's Discuss Expectations
Will Spouse/Significant Other Be Supportive?
*
Yes
No
I'm Not Sure
Support & Connection
The commitment encourages connection with at least one other person, for support and accountability. Ideally, multiple connections with others facilitating/participating will also be in place. Please select the phrase that best describes your connectivity:
Support & Connection
*
I don't feel I have a strong, healthy connection for support throughout the commitment
I have connections, but don't feel they are positive and healthy enough to support me throughout the commitment
I have good connections, but not sure they would challenge me to remain committed throughout
I have strong, healthy connections that will lovingly challenge me to remain committed
I desire a strong healthy connection and I'm open to being vulnerable and establishing the necessary connection(s) for this commitment and beyond
Your Current Place with Christ
Where are you with Jesus as Lord & Savior?
*
Do not know Christ
Know about Christ
I desire a Savior
He is my Savior
Jesus is Savior + I serve in the church/other capacity
Jesus is Savior + I serve, but sense there's more
Jesus is Savior, but I am/feel broken
I'm in need of healing & Jesus to be Lord
I have a great love for Jesus as Savior AND Lord
My great love for Jesus as Lord & Savior causes me to love others
Select one best describing current devotion life:
*
No desire for devotion life
No time for devotion life
Desire devotion life, but struggle with time & consistency
Newly consistent with devotional life
Seasoned believer with consistent devotional life
Are you currently part of church home? If so, where?
*
Are you open to/familiar with prayer & fasting?
*
No
Yes
Your Current Nutrition
Are you familiar with whole foods nutrition?
*
No
Yes
Somewhat
Are you willing to plan and prep meals week to week?
*
No
Yes
I need to learn more
Are you willing to cook during the commitment?
*
No
Yes, if recipes are provided
Biggest Weaknesses
*
Sugar
Alcohol
Bread/Pastas
Dairy
Creamy/sugary coffee
Fast food
Describe your current nutrition lifestyle:
*
Take an honest assessment of where you are nutritionally. Describe what you tend to eat on a normal day.
Are you willing to keep a food journal?
*
No
Yes
If one is provided
How much water do you consume per day?
*
Describe in cups or ounces
Do you currently take supplements or vitamins?
*
Please describe current regimen
Your Current Fitness
Do you currently workout?
*
Yes
No
How often?
*
0 - 1 times per week
2 - 3 times per week
4 - 6 times per week
What type of workout(s)?
*
Strength/conditioning only
Cardio only
Mix of strength & Cardio
Where do/will you prefer to workout?
*
Home
Gym
Private, instructor-led boutique setting
Describe your fitness perspective and approach:
*
Do you have physical limitations? Please describe:
*
Sleep
Getting an adequate amount of sleep for your unique needs is just as important as all other components to the commitment. After assessing your current sleep patterns, and energy level throughout the day, are you willing to commit to getting enough rest throughout the commitment?
Will you commit to adequate sleep?
*
No
Yes
Let's discuss
Communication & Check-In Preferences
As mentioned before, strong, healthy connections with others is
critical
for beginning, continuing and completing the
Mighty Method
. Please share below, your preferred methods of connection and realistic, weekly check-in opportunities.
Preferred Personal Communication
*
Email
Facebook Messenger
Text
Would a Facebook Group Be Helpful?
*
Yes
No
Do you have health concerns/issues? Please share.
*
Please share WHY you're eager to journey through the Mighty Method
*
Please share your personal motivation for completing the Rise Up Commitment and how I may begin to pray for you now.
Submit
Home
For You
MIGHTY Coaching
Art
>
Isaiah 53
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