Nutrition Group Interest

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

THANK YOU for taking a quick moment to send me this survey!
I'll reach out with details and options ASAP once I receive it from you.
Marion :)

Email *

Name *

Instagram Handle

Let's talk about energy! Because honestly? It is EVERYTHING! *

Honestly, I feel like crap. My energy is non-existent and I struggle to stay positive.

Mood swings are pretty normal for me. My energy is up and down and so is my mood.

My energy is pretty high and I consider myself well balanced and generally positive

I have AMAZING energy all the time. LOVE LOVE life. TODAY IS THE BEST DAY EVERRRRRR!

Tell me about your current eating habits? *

I eat clean. No processed foods allowed.

I eat generally well but fall off the wagon every now and then and have to get back on.

I know about healthy eating and make a conscious effort... but late night eating ice cream or potato chips are kind of my jam.

Fast food, sodas, and packaged snacks are just part of my daily life

Other:

Check all that apply: *

I am constantly reaching for carbs/starchy foods and can't seem to stop craving them

I am constantly hungry and can't seem to ever feel satisfied

I eat "healthy" but do not see any changes

I think about food ALL THE TIME!

Food and coffee are my regular "pick me ups!"

I eat even when I am not hungry... It's habit, but I cannot stop

I've avoided social situations, because of negative feelings and even physical symptoms I have had from overeating

I eat different in private than in front of people

I just want to snack all day long

I eat when I am bored

I feel like my life will begin when I finally lose the weight

I just always feel like I am on some sort of diet

I feel addicted to sugar/carbs

I just feel STUCK!

Other:

Required

Is there anything you want me to know? Or anything you want to share with me about how you are feeling right now and how you WANT to feel?

That's it! Once you hit "SUBMIT" I'll send you an email with info so you can see if this program sounds like it would be a good fit for you or not. **PLEASE CHECK YOUR SPAM FOLDERS as my emails like to hang out in there apparently ;) I look forward to learning more about YOU and hopefully working together! Marion <3

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms