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Weight Coaching: Consult Call Prep

This questionnaire is the first step to working with me.

After answering the following questions, we will schedule a 30-minute consult call to chat about your responses and confirm that working together will be a great fit for both of us.

Taking the time to thoughtfully complete this questionnaire will help us to have the most impactful time together.

XO,

Jenn

Click the button below to start.

Start

Question 1 of 11

What's your first and last name?

Question 2 of 11

What's your email address?

Question 3 of 11

What's the best phone number where you can be reached?

Question 4 of 11

Have you ever worked with a Life/Weight/Success Coach before?

If YES, please describe your experience.

If NO, simply type "No."

Question 5 of 11

Which of the following do you feel holds you back from achieving your weight loss goals?

(Select all that apply)
A

Lack of Support

B

High Stress Levels

C

Not Enough Time / Busy Schedule

D

Money / Expense of Healthy Options

E

Lack of Willpower

F

Trouble Committing To Change

G

Poor Body Image

H

Other

Question 6 of 11

In what ways is your current weight / body image affecting your life?

(Select all that apply)
A

Little to no desire to go out and be social.

B

Avoiding activities with family/kids.

C

Minimal (if any) sex drive.

D

Moody around people eating certain foods.

E

Feeling like a failure.

F

Resentful of my body.

G

Embarrassed to be seen.

H

Other

Question 7 of 11

Referencing your selections from the previous two questions, what is your CURRENT reality in each area vs. what you DESIRE it to be?

Question 8 of 11

Why is NOW the time for you to tackle the emotional and mental roadblocks surrounding these issues?

What will your life be like if you DON'T tackle these roadblocks? What is it costing you to remain the same?

Question 9 of 11

What would you like to accomplish in your coaching? 
How will you know if coaching has been successful for you?

Question 10 of 11

On a scale of 1 to 10, how ready and willing are you to dig deep, get a little uncomfortable, and finally tackle these issues once and for all? (Choose one)

A

I'm a 10! Whatever it takes, I'm ready to feel happy and fulfilled in my life.

B

I'm somewhere around 7-9. I know I want to change, but I have a little hesitation and fear around if I can do it and/or how all this works. {if this is you, I gotchoo!}

C

I am a 6 or lower and not sure if I'm ready to transform my life at this time.

Question 11 of 11

If we decide this program is the right fit for you, are you ready to invest in yourself in order to change your relationship with food, your body and your weight?

A

Yes! I'm ready.

B

I think so.

C

No, I do not plan to invest in my transformation at this time.

Confirm and Submit