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Preparation for Appointment

Please fill out this form so I can prepare for your appointment. 

Without an application form from you, your appointment will be cancelled. 

Click the button below to start.

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Question 1 of 16

What is your first and last name?

Question 2 of 16

What is your email AND phone number (including country and area code)?

Question 3 of 16

How did you hear about me and my 12 Week Program? 

Question 4 of 16

Have you watched the quick 17 minute video that I've requested you to watch before our chat? The link is in your confirmation email. 

A

Yes

B

Not yet, but I promise I will before we chat.

Question 5 of 16

Please select your call preference:

A

Zoom

B

Phone

Question 6 of 16

Which age bracket are you in?

A

20-35

B

35-39

C

40-49

D

50-59

E

60+

Question 7 of 16

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

Question 8 of 16

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

Question 9 of 16

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

Question 10 of 16

Briefly describe your current lifestyle: ie work hours, family life, any stresses, current nutrition and drinking habits, current exercise if any. 

Question 11 of 16

Life experiences - whether from childhood or adulthood - can sometimes shape how ready we feel to take on a structured health program. Which of the following best describes you right now?

A

I have not experienced any significant past trauma that would impact my readiness to focus on this program.

B

I’ve experienced trauma or major stress in childhood or adulthood, but I feel stable, supported, and ready to focus on this program.

C

I’m currently working through trauma, grief, or major stress (from the past or present) with professional support, and I feel ready to also focus on my health and habits.

D

I’ve experienced trauma, grief, or major stress (including childhood trauma), and right now I don’t feel ready for a structured program.

E

I prefer not to answer.

Question 12 of 16

Right now I....

A

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

B

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

C

I don't have any financial resources at all, and I'm going to have to keep working on my health and weight loss as is.

Question 13 of 16

If someone advised me to spend $2,000-$2,500 on a coaching program to help me achieve my weight loss goals, 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 14 of 16

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

A

Yes

B

No

Question 15 of 16

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 16 of 16

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

Confirm and Submit