Retreat Interest Questionnaire
Please fill out this form with as much detail as possible. Please be open and honest, knowing that all answers are confidential. I will respond via email, normally within 3 business days.
First & Last name: *
Your answer
Email address: *
Your answer
Where do you lived? (city & state) *
Your answer
When were you born? *
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Please check all categories you're interested in. *
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How did you hear about The Year Of You and/or BigGirlFitGirl retreats? *
If you looked 5 years in the future and all of your dreams had come true, what would those dreams be? *
Your answer
What's going on currently? Are you well on your way to reaching them? Or do they seem like far away dreams? *
Your answer
Are you currently on a diet or following any type of meal plan? *
Your answer
My self care routine looks like this: *
Your answer
Describe your relationship with and feelings about exercise or physical activities. *
Your answer
What do you know about mindful eating, Intuitive Eating, or the HAES philosophies? (it's okay to say 'nothing') *
Your answer
Fill in the blank: I speak unkindly to myself or about my body _______________. *
I experience anxiety on a regular basis. *
1 meaning almost none, 10 meaning it's oozing out of you, how would you rate the amount of love you show yourself? *
1 meaning miserably uncomfortable, 10 meaning you love your figure and physique, how comfortable do you feel in your body? *
Do you have a faith, religion, or spiritual practice? Tell me more about it and what kind of role it plays in your life. (Discrimination against any religion or belief is not part of this event- all are welcome. However, knowing where you stand does help me to determine how I can best serve you.) *
Your answer
What are you hoping to get out of attending our retreat? *
Your answer
Please share any questions you'd like me to answer right away. You will also have an opportunity to set up a phone call to ask questions and clarify details.
Your answer
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