Questionnaire before Coaching with Jayne Anne Ammar
Hello! Thank you for taking a few minutes to fill out the potential client questionnaire. This form will help me get to know you a little better and will help us be able to quickly gain focus and make progress in our sessions. All answers are completely confidential. If you have any questions, please email me at jayneanneammar@gmail.com. 
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Email *
Full Name *
What are you struggling with when it comes to your relationship with food, your body, or your weight? (Please list all emotional and physical issues.) *
If you could wave a magic wand, what would you like your life to look like in 12 months? *
My approach is centered around sparking new insights, cultivating self-awareness, emotional work, and unlearning old habits. How motivated are you now to truly tackle and overcome this?
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What do you think you NEED to feel neutral or even GOOD about food and your weight once and for all? *
What would it mean to you to overcome your struggle with food, emotional eating and body image and move on with your life, free of all of the stress associated with this issue?
Lastly, how did you find me?
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