Full Name
Phone
*
Email
*
When you wake up in the morning, your first thought is usually?
Ugh, I’m already tired.
Where the heck is the coffee?
Let’s go—today’s a fresh start!
How often do you pause and check in with your body during the day?
Rarely, I'm usually on autopilot.
Occasionally, when something feels “off.”
Regularly—I listen to my body’s cues.
Which statement sounds most like your relationship with food?
I eat emotionally or when I'm stressed.
I’m always trying to “be good” but struggle to follow through.
I fuel my body with intention most of the time.
When it comes to change, how do you feel?
Overwhelmed—I don’t even know where to start.
Motivated, but I tend to lose momentum.
I love growth and am always looking for the next level.
How would you describe your overall energy and clarity right now?
Drained and foggy—I’m not myself.
Up and down—I have good days and not-so-good ones.
Pretty consistent—I feel balanced and resilient.