Step 1 of 9

Let's start with the basics

Full Name *

Email *

Phone *

How old are you? *

Step 2 of 9

Let's talk about your goals

If we were celebrating a big win at the end of this program, what would that look like for you? *

Why is this important to you right now? *

On a scale of 1–10, how committed are you to making changes? *

Current Weight + Height 26gfl

Step 4 of 9 Nutrition Habits

Walk me through a typical day of eating (be as honest and detailed as possible)

Where do you feel most off track with your eating?

Afternoon

Evening

Weekends

Do you currently follow any specific diet or rules?

Yes

Have you ever counted calories before? 37bma

Yes

I am tracking now

Note: While I ask about past experiences with calorie tracking, this program does not rely on counting calories. Instead, I teach a simple plate method that helps you build balanced meals without obsessively tracking numbers.

How often do you feel:

Overly hungry
Overly full
Out of control around food

Do you struggle with emotional eating? If yes, when does it usually happen?

Step 5 of 9

Lifestyle + Environment

How many meals do you typically eat per day? *

Do you cook at home, eat out, or a mix? *

Who do you typically eat with? *

What does your grocery/shopping routine look like? *

Step 6 of 9

Almost there! Health & Body Feedback

How is your energy on a daily basis?

How is your sleep? (hours + quality)

Do you experience:

Bloating

Digestive issues

Craving

Any injuries or limitations I should know about?

Step 7 of 9

Mindset & Patterns

What has NOT worked for you in the past?

What do you feel you struggle with most when trying to lose weight?

Do you tend to be:

All-in / all-out

Consistent but slow

Start/stop

What usually throws you off track?

Step 8 of 9

Support + Coaching Style

What type of support helps you most? (check all that apply)

Accountability

Direct feedback

Encouragement

Structure / clear steps

How do you prefer I communicate with you? (direct, gentle, somewhere in between)

Step 9 of 9

Commitment

What are you willing to change or prioritize over the next 6 months?

Is there anything that might get in the way of your consistency?

Anything else you want me to know before we start?