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Application for Compared to Who Group Coaching
Are you ready to be free?
Group Coaching is an immersive experience where you dig deep into the spiritual roots of your body image issues to find freedom, hope, and encouragement you may have never thought possible! Use this form to APPLY for group coaching. If you are interested in more information, please reach out to
Heather@Comparedtowho.me
BEFORE you apply.
Prices and additional information are available on the website here:
https://comparedtowho.me/body-image-coaching/
- Scroll towards the bottom of the page, after the testimonials to read about prices, payment options, and what is included in the cost.
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Email
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Your email
What is your name?
Your answer
What is your full address?
Your answer
What is the best phone number to reach you?
Your answer
What email address do you prefer I use?
Your answer
What's your date of birth?
MM
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DD
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YYYY
What are the best dates/times for you to meet? ***Please choose your top three time slots. (Meetings are exactly one hour- google can tell you what time this is where you live!)
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Mondays at lunchtime 11am (central)
Mondays at lunchtime 12pm (central)
Monday at lunchtime 1pm (central)
Tuesdays at 6:30pm (central)
Tuesdays at 7:30pm (central)
Wednesdays at 8am (central)
I need a weekend or another after business hours time.
Other:
Required
Are you married?
Yes
No
Clear selection
Do you have children:
Yes
No
Clear selection
Tell me a little about your family (children's ages/grandchildren/any family circumstance that would give me insight into what you're current circumstances look like):
Your answer
Tell me a little about your work/education/or hobbies:
Your answer
Tell me a little about your family of origin (your parents and siblings).
Your answer
Do you have any diagnosed mental health issues I should know about?
Your answer
Do you have any physical health issues I should know about (i.e. thyroid disorders, chronic fatigue, etc. . .)?
Your answer
What do you do for fun/what activities do you find most relaxing or enjoyable when you're stressed or tired?
Your answer
Are you willing to be vulnerable and talk about some of your issues inside a confidential group of like-minded women?
Yes
No
Maybe
Clear selection
Do you understand that this 6 week course will only be effective if you put the work in...doing assigned homework, reading, and other exercises?
Yes
No
Maybe
Clear selection
When you think about doing the group coaching, what is ONE thing that you MOST want to get out of this:
Your answer
Finish this sentence: My time in group coaching will be a success if______________
Your answer
Do you understand that this is not a weight loss or exercise program?
Yes
No
Clear selection
How often do you read your bible?
Your answer
How often do you pray?
Your answer
Do you belong to a church?
Yes
No
Clear selection
Do you belong to a small group or Bible study, celebrate recovery, or other similar support group?
Your answer
Have you ever been part of a supportive small group?
Yes
No
Clear selection
Have you ever seen a professional Christian counselor?
Your answer
Have you ever participated in group therapy?
Yes
No
Maybe
Clear selection
What is your biggest fear about engaging in personal training?
Your answer
Are you currently dieting or following a specific food "plan"?
Yes
No
Maybe
Clear selection
Are you currently working with a dietitian, nutritionist, or any other health provider regarding your weight?
Yes
No
Used to be
Clear selection
Do you have at least 1 good friend-who is not a relative- whom you feel you can confide in about your body image struggles?
Yes
No
Maybe
Clear selection
On a scale of 1 to 5 (5 being he's super supportive, 1 being I haven't told him), how supportive is your husband of your desire to be free of body image issues?
1
2
3
4
5
Clear selection
On a scale of 1 to 5 (1 being barely ever, 5 being constantly), how much time do you spend thinking about changing your body?
1
2
3
4
5
Clear selection
Have you ever had an eating disorder (diagnosed or suspected)?
Yes
No
Maybe
Clear selection
On a scale of 1 to 5, how confident are you that changing your heart through this group coaching program may help you find freedom?
1
2
3
4
5
Clear selection
Have you read Heather's book:
The Burden of Better
?
Yes
No
Clear selection
Have you read Heather's book:
Compared to Who?
Yes
No
Clear selection
How do you respond when someone tells you, "You're beautiful?"
Your answer
How would you rate your relationship with the scale? (1-don't have one, 5-I weigh daily, it matters a lot.)
1
2
3
4
5
Clear selection
Do you think your body image issues affect your marriage (if married) . . .explain:
Your answer
Do you think your body image issues are having an affect on your parenting (if applicable)? How so?
Your answer
Do you prefer a trainer/coach or counselor be direct or coax you gently?
Your answer
Do you prefer to have homework, assignments and deadlines or do you prefer to just have time and space to think about things on your own?
Your answer
Do you like lots of check-ins or is once a week enough for you?
Your answer
Do you understand that this is a six-week program and refunds won't be given if you drop out early? ($500 back guarantee applies only for those who complete the course and do the work, participating in each session.)
Yes
No
Maybe
Clear selection
How much time do you spend watching television/netflix/movies?
Your answer
How much time do you spend on social media?
Your answer
Do you read/look at women's magazines?
Yes
No
Maybe
Clear selection
Do you read a lot? What kind of books consume most of your time?
Your answer
What kind of music do you prefer to listen to?
Your answer
Do you listen to podcasts? Which are your favorite?
Your answer
Have you ever had your personality type assessed? What can you tell me about your personality? Do you know your spiritual gifts?
Your answer
What else do I need to know about you?
Your answer
Why would you like to work with Heather as your coach?
Your answer
What question do you need answered before the sessions begin?
Your answer
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