AnaArwa’s Coaching Questionnaire

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?^*