AnaArwa’s Coaching Questionnaire

1. Your name^*

2. Your email^*

3. Country^*

4. Your Phone Number^*

5. How long have you been dieting?

6. How often do you think about food in a day?^*

7. Do you finish your plate or overeat because it's hard to tell when you are full?^*

8. Do you "control" what you eat during the day/week and then lose control during the night/weekend?^*

9. What percentage of your day is preoccupied with thoughts about your weight and/or body?^*

10. Have you lost weight on a diet and regained the weight back?^*

11. Do you feel ashamed or guilty when eating certain foods?^*

12. Do you eat certain foods around people and other foods alone in secret?
^*

13. Do you find yourself eating for emotional reasons even though you are not hungry?^*

14. Do you use certain exercising, restricting, dieting, or external influences to manage weight?^*

15. Do you avoid bringing certain foods into the house because you think you'll overeat them?^*

16. Do you avoid going out with friends or going to family gatherings because you think you'll overeat?^*

17. In 6 months from today, what has to have happened, both physically and mentally, for you to feel happy about your progress?^*

18. Why do you think you are a good candidate for Arwa's Intuitive Eating coaching program?^*