Break Free From Emotional Eating

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I'm excited that you're interested in joining the Program!

Please answer the questions below and know that your answers will remain strictly confidential.

If you make a good fit, I will contact you for an introductory call for us to get to know each other a little better.

There is no commitment from either side until after our quick intro call, at which point I’ll offer you a place in the program and ask you to complete the payment to confirm your place.

Email *

Name *

Email *

Do you identify as an emotional eater? If so, give me examples of why. *

What makes this program so appealing to you? *

How would you rate your relationship with food? *

Ok but could be better

Not great

Terrible

Other

Other:

What would you like your relationship with food to be? *

How comfortable do you feel with the investment required? (1500 Euros/USD upfront or 3 monthly payments of 600 Euros/USD) *

I'm ready let's go!

Uncomfortable but I can make it work

Let's talk and I will find the money if I really want to!

Required

How comfortable do you feel in a group setting? *

Super comfortable

Not so comfortable, it's a very personal topic but I want the supportive community

Other

Other:

3 words that describe you *

Any additional comments?

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