Download your FREE ebook!
1. Your name*
2. Age
3. Your email*
4. Country*
5. Your Phone Number*
6. How long have you been dieting?
7. How often do you think about food in a day?*
8. Do you finish your plate or overeat because it's hard to tell when you are full?*
9. Do you "control" what you eat during the day/week and then lose control during the night/weekend?*
10. What percentage of your day is preoccupied with thoughts about your weight and/or body?*
11. Have you lost weight on a diet and regained the weight back?*
12. Do you feel ashamed or guilty when eating certain foods?*
13. Do you eat certain foods around people and other foods alone in secret?*
14. Do you find yourself eating for emotional reasons even though you are not hungry?*
15. Do you use certain exercising, restricting, dieting, or external influences to manage weight?*
16. Do you avoid bringing certain foods into the house because you think you'll overeat them?*
17. Do you avoid going out with friends or going to family gatherings because you think you'll overeat?*
18. In 6 months from today, what has to have happened, both physically and mentally, for you to feel happy about your progress?*
19. Why do you think you are a good candidate for Arwa's Intuitive Eating coaching program?*
