Balance with Paula Enquiry Form
Name:
*
Surname:
*
Phone:
*
Email:
*
Confirm Email:
*
Age:
*
What is your main goal right now?:
*
Sustainable weight loss
Feel healthier and more energised
Body confidence and positive food relationship
What is currently holding you back from achieving your goals?:
*
Have you previously been diagnosed with an eating disorder?:
*
No
Yes - In the past but I have fully recovered
Yes - I have a diagnosed eating disorder
When will you be in a position to start coaching?:
*
As soon as possible
Within 1 week
Within 2 weeks
Within 1 month
Private 1:1 coaching is an investment, are you in a position to invest into a programme?:
*
Yes
No
Any questions you have about the programme before our call?:
Please validate your reCAPTCHA.
Submit
