Please list your first and last name

Please list your date of birth 

How tall are you?

Please list your current weight RANGE (if you feel comfortable weighing yourself, if not, please describe how you feel in your clothing and when you look in the mirror) 

Please list your GOAL weight RANGE (or please describe how you IDEALLY want to feel in your clothes and feel when you look in the mirror) 

How active are you? Please describe your typical workouts (if you workout)

How many steps do you take per day? (on average)

How much water do you drink on a daily basis? 

Please list a few examples of your typical:

Breakfast:

Lunch:

Dinner:

Snacks:

What motivated you to connect with me and join FLF? Why NOW?!

What is your goal with working together in Fat Loss Formula? Please list 2-3 priorities that you wish to focus on. 

Please list 1-3 things that you think are holding you back from losing weight and keeping it off (ie alcohol, too much snacking, weekend mentality)

What are the immediate things you'd like to work on?

What confuses you the most about losing weight / nutrition?

Are you open to tracking calories?

Are you open to weighing yourself?

Any other questions / feedback / concerns you'd like to voice before we get started?!

Are you READY to 100% commit to this journey together?