No BS Assessment
Let's Glow!!!
Hey Gorgeous!
To prepare for our call, please complete the following assessment:
First Name
Last Name
Email
Have you worked with weight loss or mindset coach before?
No
Yes, worked great
Yes, but didn't get the results I wanted
Yes, currently working with one
Have you been diagnosed with anxiety. clinical depression, ADHD, or any other condition?
Yes, but I no longer struggle with it
Yes, but I'm managing it
No
Yes, I'm trying to manage the best way I can but it can be a struggle at times
Are you currently seeing a counselor, therapist, psychologist, or other mental health professional?
Yes
No
How much weight would you like to lose?
0-20 lbs
21-50 lbs
51-75 lbs
75-100 lbs
100+ lbs
Have you tried to lose weight before?
No, this is my first time
Yes, I lost it but gained it back
Yes, but I never reached my goal
What is your age?
What is your height?
What is your current weight?
How often do you exercise?
Sendentary
Lightly Active (exercise 1-2 times per week)
Moderately Active (exercise 3-5 times per week)
Extremely Active (exercise 6-7 times per week)
What is your motivation for losing weight?
Do you have any other medical conditions such as thyroid issues that make it difficult to lose weight?
As a coach, do you understand that I cannot diagnose, treat or provide medical advice?
Yes
No
Yesss!!! Let's Lose this Weight!!!
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