Apply to the Coaching Program Please answer the following questions as best you can. If you need help understanding them you can click the + sign within some of the questions to get more detailed instructions. Your Name Your Email Your Gender Your Age Your Weight Your Height Why do you want to lose weight / change your lifestyle? What do you think is holding you back from reaching your goal? Why do you want ME to coach you? Do you have any history of an eating disorder? If yes, explain below... Do you have any injuries, mobility issues, or health concerns I should know about? If yes, explain below... Rate your current situation using the questions below 1 = not very, 10 = very How good is your current relationship with food? (please explain in box below) + How consistent are you with your eating? How satisfied are you? Do you eat mindfully? Do you practice moderation with a guilt-free mindset? Do you view all foods on a level playing field? Do you label foods "good" or "bad"? Are you always thinking about your next meal? Do you feel restricted or deprived? Do you eat what you want at restaurants? Does food control you? Etc 12345678910 How good is your current relationship with your body? (please explain in box below) + Body image has nothing to do with how you look and everything to do with how you see yourself. It is perception - not truth. So it can be changed without a change in appearance. Do you love your body? Does it prevent you from living your full life experience? Do you say things to yourself you wouldn't say to another person? Are you influenced by other people's judgements of you? Do you feel healthy, strong, energetic? Do you accept yourself as-is without contingencies? Etc. 12345678910 How good is your current relationship with exercise? (please explain in box below) + Would you choose the exercise you do even if you could never lose another pound? Do you exercise for the sheer joy of it? Or are you doing it for an outcome? Do you associate exercise with weight loss? Are you motivated to work out or do you have to push yourself to get out and do it? Do you look forward to your workouts? Do you use exercise to compensate for eating too much? Do you feel rested and recovered? Etc 12345678910 How good is your current relationship with your mind? (please explain in box below) + Are you emotionally triggered by the number on the scale? Do you get happy when you see a low number but upset when it's higher than expected? Are you coping with stress well? Do you feel motivated? Are you engaged with the process or are you frustrated with the current outcome? Do you judge your progress mostly by what your weight says? Do you value non-scale victories equally? Do you feel like a failure when you mess up? 12345678910 Do you have any specific questions you'd like me to answer?