Intuitive Eating 1:1 Coaching Application
Please complete the following questions to apply for 1:1 Intuitive Eating coaching with Naomi Katz of Happy Shapes Coaching, a certified Intuitive Eating Lay Facilitator. Your answers will be kept confidential, and filling out the application does not commit you to anything. Upon submission of your application, you'll be prompted to set up a 15-minute call with me so that we can discuss any questions you might have and determine if this is a good fit.

The cost of individually tailored coaching is $199 per month, and includes one 45-60 minute coaching call per week, worksheets/homework to be completed on your own time as needed, and Monday-Friday Voxer and/or email access to me for additional support. Additionally, I will provide you with a copy of The Intuitive Eating Workbook by Evelyn Tribole and Elyse Resch to assist in the coaching process. A commitment to at least three months of coaching is required, as Intuitive Eating is a process and change doesn't happen quickly.

Important: If you have an active eating disorder, I'm unable to work with you because it's outside of my scope of practice. (If you are struggling with this, please see NEDA for treatment options: Additionally, I am unable to accept clients with medical conditions that require dietary monitoring, as medical nutrition therapy is also beyond my scope of practice. (If you seek this kind of assistance, please contact one of the Registered Dieticians listed in the directory of certified Intuitive Eating Counselors here:
Sign in to Google to save your progress. Learn more
Email *
Name *
First and last name
Phone number *
City & State of Residence *
Age *
Pronouns *
Have you ever been diagnosed with an eating disorder? (Anorexia, bulimia, binge eating disorder, orthorexia, EDNOS/OSFED, ARFID, etc) *
Have you been diagnosed with a major physical or mental health issue in the past 12 months? *
Who, if any, are you currently seeing for healthcare / services? *
On a scale of 1-10, how ready are you to make peace with food? *
Not Ready at All
Extremely Ready
On a scale of 1-10, how willing are you to set aside weight loss goals? *
Not Ready at All
Extremely Ready
In one sentence, describe your current relationship with food. *
In one sentence, describe your history of dieting. *
In one sentence, describe your relationship with your body. *
What is the number one thing you'd like to change about your relationship with food, dieting, and/or your body? *
I offer reduced pricing for folks in financial need or who hold marginalized identities. Is this something you're interested in discussing?
Is there anything else I should know?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy