Diet Disruption: The Weight Loss Solution for Chronic Serial Dieters
Email address: *
First and last name: *
Telephone number: *
How have you come to learn about me and my work? *
Are you ready to lose weight and keep it off? *
Where are you currently in your weight loss journey? *
What's your history with weight loss? *
How much weight do you want to lose? *
On a scale of 1-10, how important is losing weight to you right now? *
When will you be ready to start? *
Why haven't you lost the weight yet? *
Do you believe healthy weight loss is possible for you? *
If so, are you at a place in your life where you can prioritize health? *
If selected - what are the reasons you’re committed to in order to do the work to lose the weight? *
Are there any issues whether physical, emotional or circumstantial that would interfere with the likelihood of your success in our coaching program (e.g. anxiety, depression, ADD, divorce, recent loss, etc.) *
Are you looking for a coach to help you lose weight, improve your health, have more energy, feel better about yourself, gain confidence, and become generally happier? *
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