Intuitive Eating 1:1 Coaching Application
Please complete the following questions to apply for 1:1 Intuitive Eating & Anti-Diet coaching with Naomi Katz of Happy Shapes Coaching, a certified Intuitive Eating Lay Facilitator. Your answers will be kept confidential, and filling out the application does not commit you to anything. Upon submission of your application, you'll be prompted to set up a free 15-minute call with me so that we can discuss any questions you might have and determine if this is a good fit.

Important: If you have an active eating disorder, I'm unable to work with you because it's outside of my scope of practice. (If you are struggling with this, please see Project Heal for treatment options: https://www.theprojectheal.org/healers-circle.) Additionally, I am unable to accept clients with medical conditions that require dietary monitoring, as medical nutrition therapy is also beyond my scope of practice. (If you seek this kind of assistance, please contact one of the Registered Dieticians listed in the directory of certified Intuitive Eating Counselors here: https://www.intuitiveeating.org/certified-counselors/)
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電子郵件 *
Name *
First and last name
Phone number *
City & State of Residence *
Age *
Pronouns *
Have you ever been diagnosed with an eating disorder? (Anorexia, bulimia, binge eating disorder, orthorexia, EDNOS/OSFED, ARFID, etc) *
Have you been diagnosed with a major physical or mental health issue in the past 12 months? *
Who, if any, are you currently seeing for healthcare / services? *
On a scale of 1-10, how ready are you to make peace with food? *
Not Ready at All
Extremely Ready
On a scale of 1-10, how willing are you to set aside weight loss goals? *
Not Ready at All
Extremely Ready
In one sentence, describe your current relationship with food. *
In one sentence, describe your history of dieting. *
In one sentence, describe your relationship with your body. *
What is the number one thing you'd like to change about your relationship with food, dieting, and/or your body? *
I periodically offer pay-what-you-can coaching for folks in financial need or who hold marginalized identities on a first come, first-served basis. Is this something you'd like to be considered for when spaces become available?
To help me better reach folks who are seeking support, can you tell me how you found me? (If you were referred by another professional, please include their name, if you feel comfortable doing so.)
Is there anything else I should know?
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