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Private 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)*

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

Are you ready to start your programme with us today? (Yes/No)*

What makes you most excited about this process?*

Are you currently receiving treatment for an eating disorder? If so please specify.*

Which of the following do you feel are important to your recovery?* (e.g. Relationship with food, relationship with body, nutrition support) 

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

Please tell us a little about what you would like to achieve through your programme.*

Email Address*

Phone Number*

Age*

Full Name*

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