Thank you for completing this questionnaire
Eat Responsively is a customized coaching program that requires you to pay close attention to how you feel and how your body responds when you eat different foods. Thanks for being curious about the program and your own health. We hope that these questions are a bit illuminating in their own right.

Keep in mind that a sample session is required before you begin to ensure that all your questions are answered. We also want to make sure that the program is a good fit and that this is the right time for you to commit to it. All answers are confidential.
 
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Name *
email address *
Age *
Which of these diets have you tried?
What's your relationship to the scale?
How old were you when you started dieting?
Eat Responsively asks that you listen to your body and eat foods that make you feel good. Do you know what foods make you feel good or make you feel lousy? Can you describe it a bit?
When it comes to knowing about good health and nutrition, where are you on this scale? *
In the dark - I need info
I know this stuff - I need accountability
Do you have moments when you feel good in your body? Describe.
The Eat Responsively Coaching Program requires commitment, candor and cooperation. Is this the right time in your life to commit to a program that asks you to change habits and attitudes, track feelings and do the work? Think about it and explain why. *
Please share information regarding any medical issues that affect your ability to eat certain foods or move in certain ways. During your first session we will do a deep dive into your health history. *
If you are female, are you:
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Please share some info ab current movement and exercise practice. What type, what role it has in your life, is it enjoyable . Add any other thoughts that come to mind, including any types of movement that you used to really enjoy but no longer seem to be present in your life.
In your own words please explain that you understand that this program is not a substitute for medical advice or psychological therapy. *
Is there anything else you would like Gari to know?
Gari is looking forward to talking with you during the required sample session. Have you booked it? You can schedule with this link right now: https://weilbachercoaching.as.me/schedule.php?appointmentType=25255746 Thanks! *
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