Start Where You Are Weight Loss Assessment
Please fill out this assessment. I'll be in touch soon about next steps for us working together.
Email address *
Name *
Would you like to receive information and updates from me via email? *
Why do you want to lose weight? *
What have you done in the past to lose weight? What has been effective? *
What challenges do you have regarding weight loss/lifestyle? *
What's your vision for your health/lifestyle 3 months from now? How about 6 months from now? *
What is your definition of success when it comes to food, weight, and body image? *
There will be no food plan given. Are you ready to learn to trust yourself and your body? *
Are you ready to change your mindset about weight loss and dieting? *
What do you hope to get out of our time together? *
Are you willing to invest 3-5 hours per week focusing on yourself so you can change your life? *
Are you ready to work one-on-one with a coach right now? *
Are you willing to invest at least $500 per month in your health and wellbeing? *
Is there anything else you would like me to know?
How did you hear about me? *
A copy of your responses will be emailed to the address you provided.
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