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HEALTH AND WELLNESS EXPERT | CHAMPION FOR WOMEN'S HEALTH | INFLUENCER & COACH.

INTAKE FORM

Thank you for taking the time to fill out this form. It will help to make our Strategy call much more efficient and allow us to maximize the time we spend on our call.

All information will be kept confidential.

Are you an entrepreneur or a busy career-focused woman? What do you do for a living? 

Do you have kids and a partner? If so, tell me a little about what you love about each of them.

What is your current relationship with nutrition, exercise, and stress look like? 





How long have been unhappy with your fitness, weight, or body?

What is your target weight or fitness goal? 

Be honest, what do you think is stopping you from reaching your fitness goals? The more detail you give us, the better we can serve you on your Epiphany call. 

What are you currently doing to try to achieve your fitness goals and/or what have you attempted in the past? How well is it working?

What are your TWO WORST and TWO BEST habits when it comes to living a healthy life? (Example: I turn to food or booze to help me cope with my feelings and stress. I drink lots of water) 

How WILLING and ABLE are you to invest right now in getting the support you need to permanently heal your relationship with food and feel gorgeous and desirable. 

Epiphany Sessions are 60 minutes and take place over the phone. Please make sure you are in a quiet and comfortable space that you can speak freely in.