Start Where You Are Weight Loss Coaching Assessment

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Please fill out this assessment. I'll be in touch soon about next steps for us working together.

Email *

First & last name *

Would you like to receive information and updates from me via email? *

Sure thing!

I prefer not.

Why do you want to lose weight? *

What have you done in the past to lose weight? What has been effective? *

What challenges do you have regarding weight loss/lifestyle? *

What's your vision for your health/lifestyle 3 months from now? How about 6 months from now? *

What is your definition of success when it comes to food, weight, and body image? *

There will be no food plan given. Are you ready to learn to trust yourself and your body? *

Yes

Are you ready to change your mindset about weight loss and dieting? *

Yes

What do you hope to get out of our time together? *

Are you willing to invest 3-5 hours per week focusing on yourself so you can change your life? *

Yes

Are you ready to work one-on-one with a coach right now? *

Yes

What would it be worth to you to be at peace with food, live in a body that feels comfortable to you, and never diet again? *

Are you willing to invest at least $500 per month for 3 months on your health and wellbeing? *

Yes

Is there anything else you would like me to know?

How did you hear about me? *

A copy of your responses will be emailed to the address you provided.

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