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Hello Beautiful

Name:
Your answer
Email:
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Phone Number:
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Mailing Address:
Your answer
Birthdate:
Your answer
Hobbies:
Your answer
First of all...I would love to know a little bit about YOU! Do you work? Are you married, separated, dating, divorced or single? Do you have children? If so, what are their names and ages?
Your answer
If I could wave my magic wand and make your weight/body/eating issues disappear, what would happen?
Your answer
What is going to happen in your life if you don't lose the weight?
Your answer
On a scale of 1-10 (10 being most committed), how committed are you to trying different approaches to losing weight...that have nothing to do with dieting?
Not Very Committed
Very Committed
Clear selection
What 3 words best describe your life right now?
Your answer
What, if anything, has helped you lose weight in the past? (It's OK if nothing has worked! You're not alone).
Your answer
What has not helped you lose weight?
Your answer
Why are you interested in working with a life coach at this time?
Your answer
Are you ready to invest the time, energy and financial resources to finally be free of your weight struggle?
Your answer
Thank you so much for taking the time to fill out this application. I will be in touch, via e-mail, within 48 hours!
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