First Contact Questionnaire

What is your biggest frustration with food and eating? (required)*

What steps have you tried to control compulsive eating so far? (required)*

meal plans, therapy, journaling...

In your opinion, what has been blocking your recovery? (required)*

Have you identified specific blocks, situations, events that make it hard for you to break free?

What do you think will happen if you don’t succeed? (required)*

What impact will this have on your well-being, health, life, relationships, career, finances...?

Do you binge? (required)*

Do you use food to comfort yourself or modulate your mood? (required)*

Do you eat mindlessly (not really aware of how much you eat when you're eating) ? (required)*

Do you have uncontrollable cravings you just can't seem to resist? (required)*

Do you obsess about food? (required)*

How happy are you with your weight? (required)*

How would you feel if you gained weight? (required)*

or how do you feel when you do?

How many times have you dieted in the past ten years (roughly)? (required)*

How old were you when you tried your first diet? (required)*

What would be the IDEAL outcome of working together? (required)*

How would it change your life? Why is that important?

What made you decide to contact me now? (required)*

Was there a specific event, epiphany, or reason?

Is there anything else you would like to share with me?

Your Name (required)*

Please enter your name so that I know who answered this questionnaire and can prepare for our upcoming call.

Age (Required)*

Please tell me your age so that I can better understand your situation.

Email (required)*