Request Your Free Weight Control Consultation with Andrew

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Let's find out if we're a good fit for one another. I will contact you by email within 24 hours to schedule your consultation.

All information you share is kept 100% confidential.

Email *

Your name *

Phone number (I will not call or text you without your consent) *

Your preferred method of communication *

Zoom

Facebook Messenger (Video)

Facebook Messenger (Text)

Phone

Other:

So that I can best serve you, it would be helpful if you check the box next to any of the following conditions that you identify with:

Binge-eating disorder

Anorexia Nervosa

Bulimia Nervosa

Other Eating Disorder

Major Depressive Disorder (Depression)

Bipolar

Borderline Personality Disorder

Schizoaffective Disorder

Other Mental Health Disorder

Diabetes

Hypothyroidism

Other Physical Disorder

None of these

Current weight (approximate): *

If you already know your healthy target weight, please enter it here:

While my program will assist you thoroughly with resources and information on nutrition and suggestions for exercise, the heart of this program involves achieving balance and harmony of your mental, emotional, and physical systems, so that you will possess the clarity, motivation, enthusiasm, knowledge, and momentum to overcome the barriers which have sabotaged your efforts thus far. Are you receptive to this approach? *

Yes

Maybe

Please use this space to provide additional relevant information (about yourself, your situation, any barriers to success you've identified, any questions, fears, or concerns that you'd like addressed):

On a scale of 1-10, how ready are you for some awesome changes in your life? *

Send me a copy of my responses.

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