Submit
What are your biggest struggles or roadblocks you encounter?  

 If you have Facebook, what is your Facebook profile name and instagram profile?
We want to make you part of our private group!
What has helped in the past, to get through these roadblocks?

If you could change or create one new habit what would it be?

How committed are you to making this challenge a success in creating some permanent habits?
Scale of 1-10?

What would constitute this challenge a success to you?

How did you hear about this challenge?
 All communication will come thru Email & Telegram.  By filling this out you are agreeing to be subscribed to the Nutrition Challenge Email Flow Series & Our Weekly Newsletter.  
If you unsubscribe at any time you will not receive your Scoring Spreadsheet. 
Do you agree to being added to this email list? Y or N

Office Hours: Mon-Fri 9AM-5PM
507.210.9430 | summithealthandwellnessforall@gmail.com

Thank you! Your goal setting worksheet has been received successfully. We absolutely can not wait to get to know you better. We will be in touch as soon as possible.

Nutrition Challenge Intake Form