Apply for 6 Weeks to Glow Nutrition & Lifestyle Coaching Program
Have you worked with health/nutrition coach before?
How much weight would you like to lose?
Have you lost weight before?
Yes, but it was a few pounds
Yes, I lost a significant amount of weight and gained it back
Yes, I have lost weight but am at a plateau
No, I have not lost weight
What would change for you or what would you be able to do once you reached your goal weight?
In order to reach this goal, what do you feel like you need most?
Mindset to help me rebuild my confidence, get started or keep going
Nutrition advice because I really don't know what I should be eating
Lifestyle advice to help me make better choices and decisions on how to live so I fit in my new regimen and stick with it
Behavior changes to help me deal with mindless snacking, emotional eating, boredom eating or stress eating
What have you tried in the past to lose weight?
Are you in a position to invest today?
Yes, I can invest now
No, I am not able to invest anything right now but am interested in learning more about your services
Why is now the best time for you to start working towards your weight loss goals?
When would you like to hire someone to support you in your weight loss goals?
I don't know
Spaces to 6WTG are limited. Why do you feel YOU are the best fit for this program?
What is your current profession?
Please list any medical/hormonal issues that may affect your weight loss journey.
Do you currently or have you ever dealt with disordered eating or an eating disorder?
How often do you find yourself eating out of either boredom, stress or due to emotions (both positive and negative)?
1-3 Times Per Month
On a scale of 1-10, with 10 being the highest, how would you rate your daily stress level?
On a scale of 1-10, with 10 being the highest, how committed are you right now to investing into your health, happiness and wellbeing?
Are you currently under supervision of doctor, psychiatrist, or any healthcare professional for either mental or medical care?
Do you understand that I cannot treat, diagnose or prescribe any medical illness?
I’m ready to glow!
I’m ready to glow 💫
Jay is 53 and she was believing the lie that she couldn't lose weight due to her age💚
I’m ready to glow 💫
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