Private Coaching Application

Please complete the questions as best as you can.

Whatever comes up as your initial response is good.

After you've completed the application schedule your Coaching Consult call on Zoom. You'll get the link to do this at the end of the application form and also in the confirmation email (please check your Junk/Spam folder if you don't see it in your inbox.

Your Coaching Consult Chat is a 30-minute call where we'll talk through your goals and how we would work together to achieve them. I'll share details of what it will be like to work with with and you can ask anything you like about coaching with me or the programme that we'll work through together.

This is a free no obligation call. If you have any questions please email [email protected].

Click the START button to begin.


Question 1 of 14

What's your name?

Question 2 of 14

Please provide your email address and phone number.

Question 3 of 14

What are you weight, food and health related goals? 

Question 4 of 14

Why are your weight, food and health related goals important to you?

Question 5 of 14

Tell me about yourself.

Question 6 of 14

If you could wave a magic wand, what would your ideal relationship with food look like? How would you be eating? What would you be thinking? How would you feel?

Question 7 of 14

How are things going in life generally (health, work, financial, family, relationships)?

Question 8 of 14

How old were you when you first became unhappy with your weight?

Question 9 of 14

What have you previously done to change your eating and/or lose weight? What has worked? What hasn't?

Question 10 of 14

What do you think makes losing weight difficult for you?

Question 11 of 14

Why do you not want to be struggling with your food/weight challenges one year from now? 

Question 12 of 14

What will it be like for you to have achieved, or be well on your way to achieving, your weight/health/food goals in one year's time?

Question 13 of 14

Are you willing to do what it takes, challenge yourself to get out of your comfort zone, eliminate excuses and be fully committed to your own success?





Question 14 of 14

Are you willing to make the financial and time investment required to solve these challenges and get the results you want? Why or why not?

Confirm and Submit