LEAN Gut Mind Method Intake Form

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Hi Beautiful,

Hi Beautiful,

Please fill out these next questions honestly so I can see if you are a good fit for my LEAN Gut Mind Method coaching services. If you are I'll be in touch soon to book a discovery call with you!

15Questions

1
Name
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Area Code
Phone Number
4
Age
5
Where do you currently live? (Country and City)
6
Describe your health journey up until now including things you've tried (please let me know if you have a diagnosed eating disorder or history of one).
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Ok
Ok
7
Why do you want to work with me?
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Ok
8
What is your main complaint when it comes to your health?
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Ok
Ok
9
What gut problems/ symptoms do you suffer from?
Constipation
Diarrhoea
Bloating
Wind/ Gas
Abdominal Pain
Nausea
Vomiting
Reflux
Irritable Bowel Syndrome (IBS)
Unknown Food Intolerances
I don't have any gut issues
Other Types of Gut Issues
10
What are 3 goals you NEED to accomplish to improve your health?
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Ok
11
Be honest, what is stopping you from accomplishing these goals right now? (The more specific you are the faster I can decide if you are a good fit for LEAN Gut Mind Method)
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Ok
Ok
12
How ready and committed are you to start working on your goals/health right now? Choose a number from 1-10[1 = No commitment, I'm too busy right now] [10 = I am 100% committed and NEED to change my life!]
13
Do you have the resources and time to invest in YOUR health now?
ABSOLUTELYNOT REALLY
14
If accepted into LEAN Gut Mind Method and my 1:1 Coaching, will you let me hold you accountable to your highest self and call you out on your self sabotaging behaviours or negative thinking patterns if necessary (including on our discovery call?)
ABSOLUTELY NO
15
Can you afford to invest at least $1,000/month on your health (knowing that LEAN Gut Mind Method is a 3 month program).
ABSOLUTELY NO
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