Back on Track: Getting Started Reflection

Approximate time: 5–7 minutes

We are glad you are here.

Before beginning the Back on Track course, this brief reflection helps HIW better understand your current goals, priorities, motivations, and areas where educational wellness support may feel most meaningful.

Your responses can help clarify what you hope to gain from this experience, what may support your follow-through, and where you may want to begin.

Please answer based on your current reality. There are no right or wrong answers… only useful information.

Please select at least one response for each question unless otherwise noted.

First name

Last name

Phone / WhatsApp Number

What inspired you to join the "Back on Track" course? (Select all that apply)

I want to strengthen my body, feel more energized, and support my physical wellness.

I want a deeper understanding of whole-person wellness and how different aspects of health connect.

I have health-related concerns and want to explore educational, lifestyle-based wellness support.

I am looking for practical strategies to support mental and emotional well-being.

I want to create meaningful wellness goals and develop sustainable ways to stay with them.

I want to reconnect with my body, daily awareness, and inner wisdom.

What are you hoping to gain from this experience? (Select all that apply)

Practical tools and strategies… I want science-informed methods for supporting a healthier daily rhythm.

Personalized guidance… I want insights that respect my unique wellness journey.

A supportive community… I value connecting with others on a similar path.

Health and wellness education… I want to understand how daily habits may influence overall well-being.

Goal-setting clarity… I want structure and direction to help me stay engaged.

How motivated are you to make positive changes in your wellness journey?

I feel ready to begin and would like clear next steps.

I feel motivated, and I would benefit from structure, support, and accountability.

I am interested, but I am unsure where to start.

I want support, but I sometimes struggle with motivation or consistency.

I am curious and open to learning more.

Anything else? Share your thoughts! We’re here to support you.

Your thoughts matter! Share any specific goals, concerns, or personal insights that could help us better support you on this journey.

Please consult with a qualified healthcare provider regarding persistent, severe, new, unusual, or concerning symptoms; medical conditions; mental health concerns; medications; pregnancy; breastfeeding; injury or surgery recovery; pain; changes in appetite, weight, sleep, energy, digestion, elimination, mood, physical function, or general well-being; and/or before making adjustments to diet, supplements, herbs, movement, or daily routines.

For urgent, crisis, or emergency concerns, please contact local emergency services or an appropriate crisis-support resource in your area.

Acknowledgment & Agreement*

I have read, understand, and agree.

I confirm that I am 18 years of age or older.

I understand and agree that use of this form, HIWLive.com, and any HIW LLC services, programs, resources, or materials I choose to access is subject to the HIW policies, agreements, and terms linked below and/or available in the website footer.

Privacy Policy – Code of Conduct – Participant Waiver & Educational Coaching Agreement – Terms & Conditions Policy – User License – Disclaimer – Forms Disclaimer

I understand that the HIW Live website (www.hiwlive.com) is operated by HIW LLC.

HIW LLC provides professional, educational, wellness-focused guidance, supportive services, practical lifestyle education, self-reflection tools, wellness resources, and accountability support designed to support individuals in exploring sustainable habits, self-empowerment, and whole-person well-being.

HIW LLC does not diagnose, treat, prescribe, provide medical care, provide mental health therapy, crisis care, emergency care, or replace licensed medical, mental health, nutrition, emergency, or other regulated healthcare services.

I understand that any decisions regarding my health and well-being remain my responsibility, and that the information I provide is accurate to the best of my knowledge.

I have read and understood the HIW LLC Wellness Services Disclaimer above.

Back on Track: Getting Started Reflection

Your Guide