Contact

Full Name *

First Name

Last Name

Phone Number (with area code and country code if applicable) *

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What are your biggest struggles when it comes to food and body? (Choose all that apply) *

I shame/judge/criticize myself about my body or with food.

I struggle with emotional eating/binge eating/stress eating.

I want to "listen" to my body and "trust" my body with food, but don't know how.

I never feel worthy/attractive/good enough because of my body size/weight.

I feel like my food/body struggles are holding me back in living my life.

I want to take "better care" of myself and be healthy (physically, emotionally, mentally) but don't know how.

I'm working on "Intuitive Eating" but it's confusing and I'm not sure I'm doing it "right."

Other

Are you in a place to make a financial investment in this program if we both agree the program meets are your needs to reach your goals? *

Yes, the investment is no problem! This is VERY important to me.

Somewhat - I can be resourceful!