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Preparation for Appointment

In preparation for our call, please fill out and submit this form to me at least a day before, so I have time to go through it and prepare myself for our conversation.

If you do not fill out and submit this form, your appointment will be cancelled,

Thank you, 

Em xx 

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Question 1 of 11

How did you hear about me and my 14 week Nutrition, Mindset, Stress Reduction Solution?

Question 2 of 11

Which age bracket are you in?

A

20-24

B

25-29

C

30-34

D

35-39

E

40-44

F

45-49

G

50-59

H

60+

Question 3 of 11

What is your biggest frustration with your body and/or health?

Question 4 of 11

What are you hoping to achieve with your health and/or body?

Question 5 of 11

What do you think your biggest obstacle is to achieving this goal?

Question 6 of 11

Briefly describe your current lifestyle - family dynamic, stressors, work hours, hobbies/life balance, sleep quality, as well as your current nutrition, drinking and movement habits you'd like to share.   

Question 7 of 11

Right now I....

A

Have the financial resources to invest in myself and my long term weight goals, mindset and health.

B

Have options to access the financial resources to invest in myself and my long term weight goals, mindset and health.

C

I don't have access to any financial resources at all, and will need to continue to work on my health goals as is

Question 8 of 11

If someone advised me to spend $1,000-$1900 on a coaching program to help me achieve my weight loss goals, reduce my stress, gain energy and body confidence, I would...

 

A

Know it's what any serious and committed woman needs to do to move forwards.

B

Be a little cautious, yet with a proven system I would do it because I'm serious about my health.

C

Avoid at all costs, because I need/want to do things as cheaply as possible.

Question 9 of 11

I believe working with a qualified and experienced health practitioner is a worthwhile investment. 

A

Yes

B

No

Question 10 of 11

I will call you at the time you chose. Please commit to your appointment time by typing this sentence in the box below: "Yes, I promise I will answer the phone/zoom for my health strategy appointment"

Question 11 of 11

Finally, what's the single most awesome thing about YOU?

 

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