Form: Ready to Begin — Aging with Vitality and Body Liberation

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Time Zone

Date of Birth

YYYY

Please give me a summary of your experiences with the diet industry.

Are you (mostly) ready to ditch dieting?

Please give me a summary of your experiences with the wellness industry.

(examples, are detoxes, cleanses, and “lifestyle” choices that affect your eating and activity)

Are you currently engaged in these behaviors?

Please give me a summary of your experiences with the fitness industry.

Are you currently engaged in these behaviors?

Do you believe you have an eating disorder?

If so, please tell me more about the history of your disorder and any treatment you have received.

How would you describe your relationship with your body?

Are you currently working with a therapist? If so, does this work include your eating, activity, and body image? Please elaborate.

Are you currently working with a Registered Dietitian/Nutritionist?

How do you feel about sharing this process with a group of women?

Is there anything else that you would like to tell me about yourself?

Ready to Begin Aging with Vitality and Body Liberation?

I'm so delighted that you're here. You'll be stepping into a group process with inspiring women and getting support for nourishing and caring for yourself free of ageist diet and wellness culture messages.

Before we begin this process, I want to ensure that we are a good fit for one another, as best I can. This process is very personal and can sometimes feel rather tender. My intention is to create a safe space for you and all of us

What to do first: Please complete this "Are you Ready?" Questionnaire in the next 48 hours so I can understand more about you and your goals before we begin.

Warmly, Deb

Ready to Begin Aging with Vitality and Body Liberation?

What to do first: Please complete this "Are you Ready?" Questionnaire in the next 48 hours so I can understand more about you and your goals before we begin.

Blaze a liberating new path to a respectful, nurturing relationship with your aging body. ♡