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Sunflower Group Coaching Application
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Name
Your answer
Email
Your answer
What are your biggest concerns about food?
Your answer
What are your biggest concerns about your body?
Your answer
What are your biggest concerns about your health?
Your answer
Have you dieted in the last year? If so, which diet(s)?
Your answer
How is your current body image? (1= terrible, 10 = fantastic)
terrible
1
2
3
4
5
6
7
8
9
10
fantastic
Clear selection
How often do you experience bad body image days?
Multiple times a week
About once a week
A couple of times a month
Rarely
Clear selection
Do you binge?
Yes
No
Not sure
Clear selection
Do you experience negative emotional eating?
Yes
No
Not sure
Clear selection
Are you ready to let go of the diet mindset, become an intuitive eater, and feel relaxed and free around food?
Yes!
I am, but I'm scared
I'm not sure
No
Clear selection
Are you ready and able to invest in coaching?
Yes!
Undecided
Clear selection
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