First Name
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Where are you based? (city / suburb)
Country
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What's prompting you to apply now?
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What does eating look like for you right now? What's working and what isn't?
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What would you most like to change in the next 12 weeks?
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How ready are you to make this a priority over the next 12 weeks?
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Ready now - this is a priority
Keen, but I'd need to plan around a busy period
Just exploring for now
What has got in the way when you've tried to change this before?
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Premium is Monique's most personal, high-touch programme. If it's the right fit, are you in a position to invest in this support now?
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Yes - if it's the right fit, I'm ready to invest now
Yes, within the next month or two
Not right now - I'd like to hear about other options
How did you hear about Monique?
Submit my application