The Watering Mouth Private Weight-Loss and Life Coaching Application
Hi there!! Nancy here. :)

Please fill out this Application to give us an initial idea of the things you are struggling with. If we are a good match, we will then reach out to you to schedule a free 30-Minute Mini Session to discuss your Success Strategy.

Please note that preference is given to those who fill this out this Assessment thoroughly.
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1. Name *
2. Email *
3. What is your age? *
4. How did you find Nancy?
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5. What is the greatest outcome you would love to achieve from doing a Private Coaching Program with a Watering Mouth Certified Life and Weight Coach? (i.e. weight-loss, becoming a Nutritarian, ending binge-eating, long-term health, disease prevention/reversal, improve relationship, etc) *
6. If you could change 3 things in your life & relationships over the next 3 months, what would they be, in order of importance? *
7. What do you think are your biggest obstacles in reaching your ideal potential? *
8. How do you ideally want to feel in your body and how do you want to experience your life? Explain how that is different from what you are experiencing now. *
9. If you were convinced that our private coaching program would create the lasting, long-term results you are looking for, would you be willing and able to make a serious financial investment at this time?
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10. On a scale of 1 - 5, how important is it for you to overcome your weight loss obstacles, end your weight struggle and achieve your goal NOW? *
Not important at all
Extremely important and ready to take action NOW
11. Is there anything else you'd like me to know about your situation?
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