* 1. How long have you been struggling with your weight or body image?

* 2. What are the specific challenges you’re dealing with?

* 3. What effect is a negative body image or extra weight having on your life now?

* 4. If you don’t resolve it, what will the long-term costs be to you?

* 5. Do you believe that your negative body emotion is contributing to a weight and/or food problem?

* 6. Please tell me how you found my website.

* 7. Thank-you for your responses! Please provide your email address, phone number and your time zone and I'll be in touch to schedule your Complimentary Body Image Breakthrough Session!