Consult Intake

Hey there! Ready to ditch the diet and lose weight? Complete the brief questionnaire below! 

How often do you eat when you are bored, lonely, stressed, anxious, sad or how often do you find yourself mindlessly eating?
How often do you eat take-out or dine at restaurants?
Do you currently have any physical limitations or injuries?
Are you currently or have you ever been treated for depression?
Have you ever been treated for disordered eating or any eating disorder?
Do you have children?
Are you currently pregnant or lactating?
Do you currently have a support system to help you reach your weight loss goals?
If you need additional support with reaching your weight loss goals, are you able to financially invest in hiring a professional to help you?
Are you ready to start losing weight right now?
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