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How did you hear about Empowered Eating?
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What are your biggest challenges right now related to your health and wellness?
Which of the following apply to you?
My weight has yo-yo'd up and down as an adult.
I have tried one or more weight loss programs in the past.
I consider myself an emotional or stress eater.
I often feel shame, guilt and/or out of control with eating.
I struggle with stress and burnout.
At times, I struggle to feel good about my body.
What are 3 personal health goals you hope to achieve in the next 3-6 months? Be specific.
Have you worked with a Dietitian before?
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No
Do you feel ready to work on your relationship with food and your body at this time?
Yes! I am ready!
Is there any other information that you feel is important for me to know?
I have read and agree to the terms and conditions for enrolling in the Empowered Eating Program.
Yes
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