40 Day Reset Readiness Questionnaire Question Title * 1. Do you have a health challenge that you hope will be helped by removing gluten, dairy and/or sugar from your diet? If so, please explain Question Title * 2. What are the specific challenges you’re dealing with in giving up gluten, dairy and sugar? I can't get my family to eat that way I don't have time to prepare healthy food Healthy food is outside of my budget Not knowing what to eat instead Emotional Eating Not enough nutrition knowledge I have difficulty with cooking Late night eating Other (please specify) Question Title * 3. What effect do you think gluten, dairy and sugar may be having on your life now? joint or other physical pain I can't reach a healthy weight lack of enjoyment of life lack of self respect that I haven't been able to do this on my own autoimmune condition or other serious health concern poor role model for my children other health risks negative effect on my intimate relationships low energy, fatigue or general malaise bloating or gastrointestinal problems poor sleep low moods or depression acne or other skin issues headaches Other (please specify) Question Title * 4. If you don’t master food now, what will the long-term costs be to you? I may never see how good I can really look and feel I may suffer with extra weight for rest of my life I may feel like a failure with food for the rest of my life I may never have the relationship I really want My children may struggle with the same challenges I'm facing now My health could deteriorate and my quality of life will be very poor My intimate relationship could suffer or even dissolve I may never overcome my health challenges I may be depressed for the rest of my life I may struggle with diets and weight loss attempts for the rest of my life I may waste a lot of time, money and energy trying things that don't work (i.e. new diets) I may never do that important thing that I want to do after I master my health (i.e. write a book, go back to school, start a business) Other (please specify) Question Title * 5. Have you tried something like this before? If yes, what was your experience? Question Title * 6. Do you have any medical conditions that you think may make it inadvisable to give up gluten, dairy and sugar? Yes, medicated Yes, not medicated No Other (please specify) Question Title * 7. Do you have any history of depression or other mental health disorders? If so, are you medicated for those conditions? Yes, not medicated Yes, medicated No Other (please specify) Question Title * 8. Do you have any experience with EFT (The Emotional Freedom Technique)? If yes, how much? Yes No Other (please specify) Question Title * 9. Thank-you for your responses! Please provide your email address and phone number and the best time to contact you and I'll be in touch to answer your questions and see how I can best serve you. Done