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You've tried every diet or followed food rules for so long that you can no longer listen to your body, are obsessed with food, feel guilty for eating foods you love, and wish you had more confidence in your body. You're finally ready to ditch dieting for good but feel like you can't do it on your own.

I know this feeling myself, and I've worked with hundreds of people who have felt the same way. I'd love to help you finally:

- feel confident and comfortable in your body
- honor your hunger and fullness
- find joy in movement, rather than punishment
- remove guilt, shame, and angst from food
- finally live the fulfilling life you deserve

Please take a few moments to fill out the questionnaire below! These questions will help us determine the best way that I can support you.

Full name *

Email address *

Phone number *

Date of birth *

YYYY

Which of the following best describes your current relationship with food? Check all that apply. *

I feel out of control around certain foods

I feel guilty about foods I eat, especially ones that I consider unhealthy

I struggle to recognize when I'm feeling full, and/or I often eat beyond fullness

I think about and obsess over food all the time

I wish I could eat intuitively and listen to my body

I sometimes feel addicted to food

I engage in "all-or-nothing" thinking when it comes to food

I struggle with binging and/or emotional eating

Social situations cause me stress and anxiety; I wish I could just enjoy the food and people I'm with!

I am ready to be DONE with all of it!

Other:

Required

Which of the following currently resonates with you regarding your body image? Check all that apply.

I wish I had more confidence in my body

I feel obsessed with the number on the scale

I think about how my body looks all the time and believe that if I lost weight, I'd be happier

How my body looks is a big source of stress and anxiety for me

My weight and/or the way I feel about my body impacts my food choices

I want to be able to go on vacation or look forward to an event without worrying about my body

My lack of confidence in my body makes it harder for me be social or live my life to the fullest

I am often bodychecking and my mood fluctuates depending on what I see or feel

Other:

Which of the following best describes your current relationship with exercise? Please check all that apply.

I feel guilty if I miss a workout, even if I feel like I need to rest

I exercise to "make up" for things I eat and/or to give me "permission" to eat certain foods

The thought of beginning an exercise regimen is daunting to me

Exercise feels like punishment to me

If I don't break a sweat, I don't feel like I'm exercising enough

I really want to have a healthier relationship with exercise, but don't know where to start

Other:

If you no longer struggled with the above issues, how would your life change? What would you want your life to look like? (For example, enjoying holidays without stressing about food; not feeling pressure to diet before a vacation; choosing foods based on what you want and not what you "should" eat; not caring about your clothing size or number on the scale; etc.) *

I offer both individual and group nutrition counseling. For individual sessions, my rate is $250, and we will meet once per week. My 16-week group program, Body Connected Eating, is 5 monthly payments of $399. How comfortable are you making this kind of investment at this time?
*

One of these will be great - I’m in! I need this!

That’s out of my budget…do you have other options?

How would you like to work together?

I’d prefer individual

The group, Body Connected Eating, sounds great!

I’m not sure. Can we discuss options?

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