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Hi there!

Please take a few moments to fill out this form to apply to work with me.

Anything you write here is held in complete confidence. Please share as much as you can! This will help me get to know you and get a feeling if I think I can help you. If I feel I can, I’ll get back to you shortly to schedule a time to speak.

Looking forward to our chat,
Rena

What's your first and last name?
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What's your email address?
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What's your best phone number?
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Tell me a little bit about yourself - what does your day to day look like?
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Tell me about your past/present relationship to food & your body.
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What are your main struggles and concerns at the moment?
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What sort of support or help are you hoping for from me? In other words, how will you know that you got your money's worth?
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What's the underlying reason you want to invest in one on one coaching? What's at risk by not making a change?
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Take a moment to imagine yourself after working together with me. You've improved your relationship with food and yourself, and feel free around food. You haven't lost any weight. How do you feel?
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Anything else you'd like me to know?
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