Group Coaching Application

How did you hear about us?

If no, please specify how you would prefer for us to communicate with you?* (e.g telephone, email, Whatsapp text, Whatsapp video, text message etc.)

Are you happy to speak to our practitioner via Zoom so that she can learn a bit more about you and answer any questions you have? (Yes / No)*

What makes you most excited about joining the group?*

Are you ready to invest in your programme? (Yes/No)*

Are you ready to start your journey to making peace with food today? (Yes/No)*

Is there anything you would like to share about your journey so far?*

Which of the following are important to your recovery?* (e.g I want to feel happier in my body, I want to stop binge eating, I want to understand nutrition, I want to stop yo-yo dieting, I want to stop emotional eating, I want to find peace with food)

Please tell us a little about what you would like to achieve through this programme?*

Which of our group programmes are you interested in? (e.g. Food Freedom, Binge Recovery)

Email Address*

Phone Number*

Age*

Full Name*