Work With Me - Wellness Form

Work With
Wellness With Neeta

Welcome!

I’m so glad you’re here. This form is your first step toward a more intentional, balanced lifestyle. Whether you’re looking for accountability, simple wellness resources, self care practices or community support, I’d love to learn more about your goals so we can take this journey together.

Disclaimer:

Thank you for your interest in Wellness With Neeta. This form is intended to gather information for internal use only to better serve you and understand your wellness goals. All information shared will remain strictly confidential and will be used solely to tailor our services and support specifically for you.

PERSONAL INFO

Full Name

Email Address

Phone Number

Method of Contact

Social Handle Contact

Other Contact Info

WELLNESS FOCUS

What are you most interested in?

Accountability & Support (stay motivated and consistent with healthy habits)

Nutrition Basics (simple, everyday tips to eat better and feel better)

Essential Oils (learn simple ways to use oils for daily wellness)

Guided Journaling Prompts (wellness-focused reflections & mindset work)

Wellness for Entrepreneurs (balance business & health)

Self-Care Practices (routines, rituals, and reminders for balance & renewal)

Recipe Swap & Inspiration (share and discover easy, nourishing recipes)

Other (please explain below)

Other wellness interest

Are you interested in one of my coaching programs?

If you are interested in any of my coaching programs, which one(s)?

What’s your biggest wellness goal right now?

What’s your biggest struggle when it comes to wellness?

How much time are you looking to commit to your wellness each week?

Thank you for sharing! Once you submit this form, I’ll reach out to you with next steps and resources tailored to your goals. You don’t have to do this alone — I’m here to help.

Work With Wellness With Neeta

Work With
Wellness With Neeta