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.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy