Online Recovery - Digital Coaching
Please fill this entire application out so I can show up ready to serve you on our upcoming call!
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Address *
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Phone number *
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If contact phone number is outside of U.S., please provide Skype user name for audio only call.
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Gender? *
What form of disordered eating are you struggling with? (select all that apply.) *
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What age did it begin? *
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How old are you now? *
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How many times have you attended in-patient or residential treatment for the disordered eating? *
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Please select all treatment options you have tried or are currently trying. *
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My favorite hobbies or things to do are?
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How WILLING and ABLE are you to invest in your own freedom and recovery success? *
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Describe your level of commitment to investing in your success? (money, time, energy). FEAR is okay to have. *
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What other information should I know before you start the program?
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