Private Coaching Inquiry

Well, hello!

Please do take a moment to fill out this form and let me know what is going on in your world and what your intentions for our work together would be. After you fill it out, I’ll circle back with you by email and let you know the next steps.

Your Name (required)

Your Email (required)

How did you learn about me and my services?

Have you ever been diagnosed with Anorexia or Bulimia?

Yes, Anorexia Yes, Bulimia No

If yes, is your eating disorder currently active?

Yes No

Tell me a little about your history with food and your body image.

What do you want to be different? How do you want it all to feel?

What do you think needs to change to make that happen?

Have you begun working with the recommendations in the Peaceful Eating Kit? What tools and concepts have been the most resonant for you.

The work we do together will be intense, in the most awesome way. Cool?

Rock on. No, thanks.

Why me?

Why now?

If we decide that working together long term is the next best step for you, are you financially prepared to move forward? My packages begin at $1500. Monthly payments are available.

yes no

Anything else you'd like to share?