Weightless Intake Questionnaire for Breakthrough Session

Please fill out the form below (at minimum 24 hours prior to our scheduled call time), so that I can learn more about you to help us make the most of our time toghether!

IMPORTANT: You must answer all of the questions to confirm your spot for this gift ‘Breakthrough Session’.

Weightless

If you are human, leave this field blank.

Your Name

Last Name

Email Address

Website/URL

What is your occupation?

Tell me a litte bit about your struggle with weight loss.

What is your biggest question when it comes to weight loss?

What have you already tried to do to lose weight?

What do you see as the major challenges holding you back from reaching your goal weight this year?

What have you attempted in the past that didn't work? Why do you think it didn't work?

Be 100% honest. Why do you think you've had limited success in the past personality-wise?

What personal fears, doubts and limiting beliefs would you have to release to start realizing your goals?

On a scale of 1-10, how important is it for you to solve these challenges now…. and why?

What is it about my approach resonates the most for you?

I am committed to....(check all that apply)

making permanent diet & lifestyle changes

dedicating time to cooking

implementing a daily mindset/devotional practice

uncovering the metaphysical causes of my health issues & addressing the emotional, mental & spiritual causes

going way outside my comfort zone to get huge life transforming results even if I am afraid to

doing what needs to be done, even if I don't feel like it

investing time, money and energy in the support I need to reach my weight loss and lifestyle goals

If you and I are a good match to work together, when would you ideally like to get started?

Anything else you would like me to know?

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