Pre-Consultation Form
Congratulations for taking this positive step towards a healthier weight by getting in touch! Before your free 15-minute consultation appointment please could you fill in this quick form so I can gather some information about you, your aims and your goals to give me an idea of what you hope to gain from working with me.

My weight loss coaching services are online and are available anywhere. You do not need to live near me.

Please fill in the form and I will then be in contact.

Thank you

Claire x
Name *
Age *
Town / city *
Gender *
Email *
Phone number *
Preferred method of contact *
How did you hear about YourOneLife? *
What would you like to achieve from us working together? Your main aim. *
On a scale of 1 to 10, with 1 being not important at all, and 10 being more important than anything else, how important is it to you to work on this? *
Why have you given that number? *
What have you tried before, if anything? *
What stops you from seeking help with weight loss? Please tick all that apply or add your own
What stops you from getting started with or keeping going with weight loss. Please tick all that apply or add your own.
Clear selection
Which of my services are you interested in finding out more about, to help you achieve your aim? Please tick all that apply. *
Required
To give me a rough idea of when is best to contact you, when are you available? Please tick all that apply. I will email or text you to arrange a specific time before calling.
0600-0900
0900-1200
1200-1800
1800-2100
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Is there anything else you would like to share with me?
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