Intuitive Eating Breakthrough Session

Name *

Email Address *

Phone Number *

Skype Username

What is the biggest challenge you have right now? And why is it so important for you to solve it? *

What has stopped you from achieving this goal? What types of patterns or excuses do you usually fall into when trying to reach a specific goal? *

What other areas of your life are struggling because of your body, weight, or health being affected? *

For example: money, career, confidence, relationships, etc.

What other plans have you tried in the past to improve your health and lose weight? *

For example: trainers, nutritionists, diet plans, etc.

Why are you ready to work on this now? *

How urgent is improving your health to you? *

1

2

3

4

5

6

7

8

9

10

1 = Not Very Urgent; 10 = Very Urgent

How did you find Kerin? *

How are you currently investing in your health? *

Examples: coaches, trainers, massages, etc.

What is the amount of weight you are looking to lose? *

Private packages start at $1,500. Are you able to invest that amount if we feel we are a good fit? *

Yes

No

What do you want to come away with from your session with Kerin? *