Work with Holly- 1:1 Mentorship Application
Experience healing, wholeness and radiance in your relationship to food, body and soul.
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Email *
Hey there! How can I address you?
Hello, How did you find me? *
Please fill out the next few questions in as much detail as possible- this is for me to determine if I am the best person to help you in your healing journey *
What is your email address? *
What are your biggest struggles when it comes to food, body & body image? (binge eating/emotional eating/restriction/weight issues/food addiction/compulsive exercise..etc) *
Are you struggling with more than 1 issue? If so, what else? *
Where do you want to be 6-12 months from now? Why are you looking to make a change now? *
What have you done to try to heal/work on your situation so far? Did they help? Please elaborate. (Personal Trainers, Hypnosis, Doctors, Programs, Books, Therapist, Coaches, Alternative Medicine, etc) *
First and last name
What is your current nutritional style of eating like? What dietary restrictions do you have? *
What is a "difficult" day (around food, cravings, body image issues, binge eating, emotional eating, over-exercise etc) like for you? What time of day/situation does this occur the most for you? *
How do you "cope" or "manage" during a difficult day? How have you been making it through those days? *
What is your exercise routine like? Do you identify as someone who abuses exercise? Please elaborate. *
What is your history around dieting/restricting calories/food? What foods do you binge on? Do you usually restrict them, or do you eat them, yet binge on them? *
Which style of eating resonates with you more? *
Do you struggle or have a history of addiction? (Alcohol, drugs, recreational drug use) *
What resonates with you better? *
Which described you better *
I struggle with negative body image *
How willing you are to make changes and do things that may be uncomfortable, take time, work, effort and commitment in order to experience change? Why are you willing at this point? *
What is the biggest shift you would like to experience in your relationship to food and body? *
On a scale of 1-10, how willing are you to invest financially, mentally, physically, energetically, spiritually and with your time and efforts to experience freedom, peace and healing around your body and food? *
Are you spiritual? (I include spiritual elements/language in my work, but if you don't resonate with spirituality we can leave that out)
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When are you looking to start? *
Which program are you interested in? Please note that I've altered my coaching to purely food/body coaching. Energy healing sessions can be purchased separately if interested. *
Do you need to jump on a zoom call or are you happy to receive an invoice? *
Is there anything about you that you feel is important I know? *
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