So that I can prepare for our call, please tell me a little about your current situation.
What inspired you to book this call with me?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
What are your biggest challenges at the moment? [please tick all that apply]
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Extreme dieting\nBingeing\nFeeling guilt or shame when eating\nObsessing about food\nBody image and/or body confidence\nEmotional eating\nDiagnosed eating disorder\nDisordered eating\nGenerally chaotic eating\nOther"}
What is your goal or the main thing you'd like to change about your relationship with food / eating / body image?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":100,"placeholder":""}
On a scale of 1 (not at all) - 10 (totally), how urgent is it for you to achieve your goals?
Please choose12345678910{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Please choose\n1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}
Assuming I can help, when would you want to get started?
ASAPWith the right program, in the next 2 weeksI'm not sure - perhaps in a few months{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"ASAP\nWith the right program, in the next 2 weeks\nI'm not sure - perhaps in a few months"}
If you could reach your goals (as you wrote above), what would you be willing to invest in your healing journey?
Whatever it takes!£1000-1500£500-999Less than £500Whatever it is, I'd need a payment plan to spread the cost{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Whatever it takes!\n£1000-1500\n£500-999\nLess than £500\nWhatever it is, I'd need a payment plan to spread the cost"}
Would you be interested in group calls if the program was more affordable?
Yes, I'd be interested in group callsMaybe, I'm not sureNo, I only want to work 1:1{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Yes, I'd be interested in group calls\nMaybe, I'm not sure\nNo, I only want to work 1:1"}
How did you hear about me?
InstagramGoogle SearchYour websiteFriend / word of mouthYouTubeFacebookPinterestOther{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Instagram\nGoogle Search\nYour website\nFriend / word of mouth\nYouTube\nFacebook\nPinterest\nOther"}
Are you 100% sure you can make it at your chosen time? If you're unsure, it's better to pick another time now.
Yes, I've double checked my calendar and can definitely make the timeNo, I prefer not to commit and will book a different time{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Yes, I've double checked my calendar and can definitely make the time\nNo, I prefer not to commit and will book a different time"}