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Name

First Last

Email*

Would you like you to join my community and receive free, weekly healthy tips and recipes to your inbox?*

Yes
No

Phone number*

What country/time zone are you in?

Are you able to be available T-Th between 8am-1pm CST for appointments?*

Yes
No

Coaching calls are generally during these times and/or on these days. With one on one coaching the calls will be once a week.

Melanie typically works with women who are 40+ years old and are at a point in their life where they are able to invest (mentally, emotionally and financially) in solving their weight loss challenges for good. Does this describe you?*

Yes
No

What is your age?*

What are you health goals and what would you say have been your biggest challenges when it comes to reaching those goals?*

What have you already tried to resolve these problems?*

Why is it important to you to work on these issues?*

What has your relationship with food been like throughout your life? AND What would you say is you biggest struggle with it?*

What, if anything, have you tried in the past to reach your health and weight loss goals?

What do you feel is currently holding you back from your health and weight loss goals?*

Tell me WHY you would like to reach these goals. The more descriptive you are, the better I can help you.

On a scale of 1 to 10, with 10 being "I am VERY serious about reaching my goals", where would you say you're at right now?

What do you want to accomplish with coaching?*

Select All
Weight Loss
Overall Health
To Feel Better About My Relationship with Food and My Body

Are You Currently Following Any Type of Diet Plan? If YES, which one(s)? If NO...Why?

How soon are you looking to get started at reaching your goals?*

How did you find my coaching page? AND what makes you want to work with me?*

Are you at a place in your life where you can prioritize health?*

Yes
No

Melanie, if I decide to work with you and am selected, I'll find a way to invest in myself and my future.*

I have the necessary means to invest in my health and future.
I have the ability to get the necessary means to invest in my health and future.
I have no financial means to invest in my health and future.

Are you the final decision maker when it comes to investing in your health and well being?*

No- the decision maker will be on the call with me.
YES! I am able to make my own decisions regarding my health.

I offer flexible payment options to work with me. If you're a good fit, will you be ready to make a deposit to get started?*

YES
NO

If selected - what are the reasons you’re committed to in order to do the work to work on your health and weight loss?*