* Phone Number
How did you find out about me? If someone referred you, please let me know.
Describe your relationship with food and your body when you were growing up.
Which statement(s) best describes your relationship with food and your body now?
Check all that apply.
I'm a disordered eater and exerciser. I obsess and go to extremes in fear of losing control, gaining weight, and/or harming my health.
I'm an emotional eater. I use food to cope with stress, anxiety, fatigue, overwhelm, uncertainty, boredom, etc.
I don't have an eating problem, but can't figure out why I eat when I'm not hungry and crave sugar, artificial sweeteners, caffeine, and other stimulants.
I love how I eat and exercise, but want to maintain my lifestyle without always worrying about it.
Describe your body type.
How does your current relationship with food and your body make you feel?
Don't hold back!
If yes, please describe your situation in detail.
What other diets, supplements, programs, and methods have you already tried to heal yourself?
Describe in detail what has and has not worked for you.
Describe your typical routine around food and exercise.
Also include if your routine and attitude around food and your body varies, based on your circumstances, stress level, etc.
If yes, describe your practice and/or what interests you.
Please share all of your thoughts.
If yes, describe what you read, who you follow, what you listen to, etc.
In an ideal world, what would your relationship with food and your body look like?
If you were able to heal your relationship with food and your body, what would your life look like? How would you feel? What would you achieve?
Is there anything else you would like to share that will help me serve you?