1 | Your Details

First Name *

Last Name *

Email *

Phone *

Preferred way to connect: *

Email

Text

Best days / times to reach you: *

Weekdays

Evenings

Flexible

We promise to only send important updates and details on upcoming events

2 | What Led You Here

How did you first find us? *

What stood out or resonated for you? *

3 | Your Current Season

Age *Which best reflects where your body is right now? *

4 | What You’re Ready to Experience More Of

If the next chapter of your health felt supportive and sustainable, what would you notice? (Check all that resonate) *

5 | How Your Body Has Been Communicating

Bodies communicate through signals, not mistakes.

Anything else you would like to share with us?

6 | Your Relationship With Food

Which statements feel true for you right now? (Check all that apply) *

I eat well but my body is not responding

I think about food more than I want to

Stress changes how or when I eat

I am in control for a while, then it swings

I do not fully trust my hunger and fullness signals

I am tired of managing food

I want food to feel simpler and calmer

Anything else you would like to share?

7 | What You’ve Already Lived Through

How familiar are you with health or weight-loss programs? *

A few

Many

A lifetime’s worth

What hasn’t worked for you — even when you were committed? (Check all that apply) *

8 | Stress, Pace, and Capacity

9 | Movement and Physical Capacity

Your relationship with movement right now: *

10 | GLP-1s & Weight-Loss Medications

Which feels most true right now? *

I want to rely less on interventions over time

I want to understand my body’s signals better

I’m exploring all options

I’m just gathering information

11 | Looking Ahead

If your body felt more supported at a cellular level, what would that make possible in your life?(Check all that resonate) *

12 | Final Reflection

What have you been putting on hold until you feel better in your body? A trip, a dream, a new chapter… nothing is too big or too small. *

Picture yourself ten years from now, radiant, strong, and fully alive from cell to soul. What are you doing that lights you up? *

Anything else you want to share with us?

We'd love to meet you and support you in your journey to a THRIVING LIFE!

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