Application to Work with Me

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Question 1 of 14

I Have Previously Struggled With

(Select all that apply)

A

Binge-Eating (binge defined as overeating a food or foods)

B

Yo-Yo Dieting

C

Body Image Issues

D

Hyper-Restriction of Foods

E

Over-Exercising

F

Nutrition Confusion - Not Knowing How to Eat

Question 2 of 14

My Most Important Goal Is

A

Lose Weight

B

Change Body Composition

C

Learn How to Eat Better

D

Stop Bingeing on Certain Foods

E

Change My Mindset

Question 3 of 14

Any Other Goals You're Chasing Not Listed?

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Question 4 of 14

If you have a weight loss goal, how much weight do you wish to lose?

A

1-10 Pounds

B

11-15 Pounds

C

16 Pounds +

D

I don't have a number in mind

E

No Weight Loss Goal

Question 5 of 14

What Have You Tried in the Past?

(Select all that apply)

A

Weight Watchers

B

Noom

C

Keto Diet

D

Paleo/Grain Free

E

Calorie Counting/Tracking

F

Macro-Tracking

G

HCG Diet

H

Weight Loss Surgery

I

Other - Anything I've Tried it All

Question 6 of 14

Why Have These Diets Failed?

(Select all that apply)

A

Didn't Fit My Lifestyle

B

Made Me Sick

C

Worked for a While and Then Stalled

D

It was Too Much Work

E

I Lost Interest

F

I Missed Certain Foods

G

I Hated It

H

I Lost Motivation

Question 7 of 14

What are you willing to do to reach your goals?

(Select all that apply)

A

Track Food Consumption

B

Implement or Increase Exercise

C

Read Materials/Educate Yourself More

D

Food Prep/Cook at Home More

E

Set Aside Time Daily and Weekly for Myself

F

Explore My Relationship with Myself

Question 8 of 14

What are you NOT willing to do in order to reach your goals?

(Some of us know what does NOT work for us and THAT IS OKAY!)

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Question 9 of 14

How does your current state of health/fitness affect your emotions?

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Question 10 of 14

What will happen if you do nothing at all to chase your goals?

Paragraph answer

Question 11 of 14

What is holding you back from reaching your goals?

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Question 12 of 14

If I could buy a magic wand that would allow me to reach my goals overnight, I would pay

A

$100

B

$500

C

$750

D

$1,000

E

Over $1,000

F

Anything - reaching my goals is priceless.

Question 13 of 14

Is there anything else you want me to know about you? Tell me!

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Question 14 of 14

I want you to contact me. The best way to do so is:

(Select all that apply)

A

Email

B

Text Message

C

Phone Call

D

Do not contact me

Confirm and Submit

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Email

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Application to Work with Me

Click the button below to start.

I Have Previously Struggled With

My Most Important Goal Is

Any Other Goals You're Chasing Not Listed?

If you have a weight loss goal, how much weight do you wish to lose?

What Have You Tried in the Past?

Why Have These Diets Failed?

What are you willing to do to reach your goals?

What are you NOT willing to do in order to reach your goals? (Some of us know what does NOT work for us and THAT IS OKAY!)

How does your current state of health/fitness affect your emotions?

What will happen if you do nothing at all to chase your goals?

What is holding you back from reaching your goals?

If I could buy a magic wand that would allow me to reach my goals overnight, I would pay

Is there anything else you want me to know about you? Tell me!

I want you to contact me. The best way to do so is:

Confirm and Submit

What are you NOT willing to do in order to reach your goals?

(Some of us know what does NOT work for us and THAT IS OKAY!)