BodyEQ starts with you!

Name

First Name

Last Name

How did you hear about the program Body EQ?

Are you currently on a diet program? If so, what kind?

What has been your experience with dieting?

How would you describe your relationship with your body?

Checkbox

Which of the following describes you best?

I am a lifetime dieter but I am ready for something new.

I am looking for a healthy way to eat.

I just started a new diet.

I 'fail' every diet I go on and am feeling resigned.

I am 'good' at dieting but after a while the weight comes back on.

I do not have a weight issue and am very controlled about what I eat.

I am looking for a support group to keep me accountable on a new eating plan.

I am a coach looking for tips for my clients.

What do you want to achieve from your participation in Body EQ?

Are you under the care of a doctor? Do you have any health concerns?