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Welcome to ReFOCUS 2020
Please fill out this form so Erin & Heather can get to know a bit about you before the 2 week community begins!
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Name:
*
Your answer
Name on Facebook (if different from your name)
Your answer
What's your primary health goal?
Lose Weight
Eat Better
Find Rest
Improve Mental Health
Improve Spiritual Health
Other:
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What's your secondary health goal?
Lose Weight
Eat Better
Find Rest
Improve Mental Health
Improve Spiritual Health
Other:
Clear selection
"I loved this group so much. I'm trying to think of ways of improving it and not coming up with anything. Every single post was so well planned. I liked that both Heather and Erin would reply to people's comments. I learned tons from the posts and the videos but I also learned from the comment section." - Participant in January ReFOCUS 2020 Group
On a scale of 1-10 how would you say you feel about your body?
Hate it.
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Love it.
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On a scale of 1-10 how would rate your physical health?
Struggling with serious health issues and/or chronic disease.
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Very healthy across every measure.
Clear selection
On a scale of 1-10 how would you rate your mental health?
I battle depression or other mental health issues.
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I feel very healthy, mentally.
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On a scale of 1-10 how would you rate your relationship with food?
I don't handle it well, ever. Food is a constant struggle for me.
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I have a healthy relationship with food, I see it as nourishment.
Clear selection
On a scale of 1-10 how would you rate your sleep?
I don't sleep well, wake up frequently, or have other sleep difficulties
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I sleep well for 7 hours or more a night.
Clear selection
On a scale of 1-10 how would you rate your relationship with exercise?
Exercise is a chore, I don't like it. Probably never will.
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I have a healthy relationship with exercise--I try to move each day for sheer enjoyment,.
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On a scale of 1-10 how would you rate your spiritual health (Bible reading, prayer life, christian community)?
I'm struggling in this area.
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I feel really good about my daily time with God, my participation in Christian community and church.
Clear selection
What's one thing that you would like to get out of this coaching community?
Your answer
Have you ever been diagnosed with an eating disorder?
Yes
No
Not diagnosed, but possibly had one.
Clear selection
Have you ever participated in individual or group counseling?
Yes
No
Clear selection
Do you have any specific questions you'd like to see addressed during our time together?
Your answer
Awesome! You are IN and ready to REFOCUS your HEALTH in an AMAZING Way! We can't wait to work with you. Please choose your payment option below and we'll send you a confirmation email within 48 hours. No email? Went to spam? Reach out at:
Heather@comparedtowho.me
Price is $28 The final step is to submit your payment! You can use this PayPal address PayPal.me/sparkingwholeness/28.00 you can email:
heather@comparedtowho.me
for an invoice.
I'll use PayPal. Use this address: PayPal.me/sparkingwholeness/28.00
I'll need an invoice. Email
heather@comparedtowho.me
- An additional $1.50 will be added for credit cards fees.
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