Name: *
E-Mail: *
Phone: *
Mobile Phone:
Skype ID:
Best time to contact:
Are you available to meet in person or via skype between 9am - 2:30pm Monday - Thursday? *
Birth Date: *
Height (in cm): *
Current weight: *
Goal weight: *
Heaviest weight in your life: *
How long were you this weight? *
How do you feel that being this weight affected your health, mood, relationships, physical activity, work, productivity and/or finances?
If you were no longer struggling with your weight, how would your life be different?
If your weight problems could be resolved, what would be your dream solution?
Do you have any chronic health conditions? If so, what are they?
Why do you think you need me (Fi) to help you reach your goals?
