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ALCOHOL
SMOKING CESSATION
Hypnotherapy and The Mind
Home
WEIGHT LOSS
One to One Coaching
Journalling for Weight Loss
TESTIMONIALS
Submit Testimonial
Blog
Contact
Consent Form
ALCOHOL
SMOKING CESSATION
Hypnotherapy and The Mind
Application for 1:1 Coaching
1. Yes Amy! I want to work one to one with you, for 90 days and gain full access to your coaching, guidance and expertise within No-Diet Solution+. I understand that you will use this application to select a small handful of individuals who are committed to transforming their mind and body, to reach their ideal weight and that you will let me know within 5 business days if I have been selected.
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I agree
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Indicates required field
2. Today's Date
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3a) Name
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First
Last
b) Address
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Line 1
Line 2
City
State
Zip Code
Country
c) Email
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d) Phone Number
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e) D.O.B.
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f) Best way to contact you
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Email
Text Message
Phone call
4. I understand that I will be charged a REFUNDABLE deposit of £350 to demonstrate my commitment and reserve my place in No-Diet Solution+. If I am not accepted, this deposit will be immediately refunded.
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I understand
5. Please choose your desired Payment Plan
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I understand my £350 deposit will be deducted from my one time payment of £2000
I understand my £350 deposit will be deducted from my first payment of £700, followed by 2 further monthly payments of £700
6. Describe your current situation and eating habits
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7. What have you previously tried in an attempt to lose weight?
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8. What are the three biggest obstacles stopping you from reaching your ideal weight?
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9. What is your current weight?
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10. What is your ideal weight or dress size?
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Submit