The Watering Mouth Private Weight-Loss and Life Coaching Application
Hi there!! Cheri here. :) Please fill out this Assessment Questionnaire to give us an initial idea of the things you are wanting to be coached on. We will then reach out to you to schedule a free 30-Minute Mini Session, if we seem like a good fit.

On that call, we will discuss how my private Weight-Loss and Life Coaching Program works, and decide if it's right for you at this time.

Please note that preference is given to those who fill this out this Assessment thoroughly.
1. Name *
2. Email *
3. What is your age? *
4. What is the greatest outcome you would love to achieve from doing a Private Coaching Program with a Watering Mouth Certified Life and Weight Coach? (i.e. weight-loss, becoming a Nutritarian, ending binge-eating, long-term health, disease prevention/reversal, improve relationship, etc) *
5. If you could change 3 things in your life & relationships over the next 3 months, what would they be, in order of importance? *
6. What do you think are your biggest obstacles in reaching your ideal potential? *
7. How do you ideally want to feel in your body and how do you want to experience your life? Explain how that is different from what you are experiencing now. *
If you were convinced that our private coaching program would create the lasting, long-term results you are looking for, would you be willing and able to make a serious financial investment at this time?
Clear selection
9. On a scale of 1 - 5, how important is it for you to overcome your weight loss obstacles, end your weight struggle and achieve your goal NOW? *
Not important at all
Extremely important and ready to take action NOW
Is there anything else you'd like me to know about your situation?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.