Body Freedom Group Program Application 
I'm so excited you are here to apply for the Body Freedom Group Program with Amber Romaniuk. This is a powerful 6 or 12 month commitment to support you to food and Body Freedom. Please answer the questions below and I will get back to you within 24 hours to connect to talk about going on this journey with you. Here's to deeper healing!
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Please note you must be 21 or older to work with me.  *
Pflichtfrage
Please share your first and last name.  *
Please share the best email to reach you at.  *
How did you find out about the Mastermind?  *
YOUR GOALS: What are the three biggest changes you want to make with your health and eating in the next 3 months?
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What are the three biggest changes you want to make with your health and eating in the next year?
Your Current Life: On a scale of 1 to 5, 1 being low and 5 being high, rate your satisfaction with the following areas of your life
 *
1
2
3
4
5
Health
Body Image
Self Confidence
Job/Business
Finances
Energy
Digestion
Hormones
Eating/ Relationship With Food
How many other health care practitioners are you working with right now?*
 *
On a scale of 1 to 5 one being a low priority and 5 being a high priority how willing are you to make a significant investment in your health?
 *
Currently, what is your biggest challenge with your health, emotions and/or food? What would you like coaching on?
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Where do you want to be with this challenge/health imbalance a year from now? What do you think an ideal solution would be?
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What do you think is holding you back?*
 *
On a scale from 1 to 10 (10 being high) how committed are you to doing what it takes to transform your current challenge/health imbalance into your ideal reality?
 *
What would the best time preference for our live group calls? We will do our best to accommodate a time that works for everyone depending on the time zone you are located in. 

(Please note your 1:1 private mentorship sessions with Amber will be booked separately to accommodate your unique schedule and time zone.)
 *
How Much Are You Willing to Invest in Your Healing for a 6 or 12 month timeframe? *
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