Hey there! I'm so glad you're here. :)

It's very important to me that you get the kind of help you need. So please fill out this application as honestly and as thoroughly as possible so I can learn more about you and really get a sense of your struggles and needs with regards to food, exercise, and body image issues. My services aren't right for everyone, so this will help me to determine if I think we're a good fit.  

After I review your application, I'l be in touch with you via email.

If I feel we're a good fit based on the information you provide, we'll schedule a free 30 minute skype/phone consultation. This will give us a chance to meet, discuss the coaching process and answer any questions you may have.

If I feel that you would best be served by someone else or that your needs are outside the scope of my coaching practice, I will let you know and do my best to provide you with a referral to a more suitable resource. 

Thank you and I'll be in touch soon!
Start
 
What is your first + last name? *

 
Where do you live? *

(City, State/Province, Country)
 
How old are you? *

 
What is your Skype handle?

(If you have a Skype account.)
 
What is your phone number? *

 
How did you hear about me and my services? *

 
Describe your current relationship with food, exercise, and your body image. *

Please be as detailed and thorough as possible.
 
Ideally, what do you want your life and relationship with food, exercise, and your body to look like? *

 
What steps have you taken so far to address your food, exercise, and body image issues? *

 
Out of the things you've tried, what has been helpful? *

 
Out of the things you've tried, what has NOT been helpful? *

 
What have been your biggest challenges, obstacles and stumbling blocks to stopping the food/exercise obsession? *

 
What are your hopes and expectations for our work together? *

 
Why do you feel NOW is the right time to hire a coach and receive support? *

 
For what length of time do you see yourself committing to our coaching relationship? *


 
What is your biggest reticence and/or fear about coaching and working on this issue? *

 
What specific questions do you have for me? *

 
Is there anything else you would like to tell me or you think is important for me to know about you?

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