Breakthrough Session Intake Form Your Name (required) Your Email (required) For our time to be best spent during your breakthrough session please let me know a little more about you Please select your call preference (required) PhoneZoom Please share a little bit about your goals What has been your biggest struggle? What have you tried in the past and why hasn’t it worked? What do you feel is the biggest obstacle to you hitting your goals? What if the above obstacle was no longer a road block for you in your journey to the best version of you, how would that change your life? Briefly describe what you’re doing now to balance your hormones, change your habits around food choices and live a healthier life. Why is making this change to your life most important to you? Do you have a support system in place that will help you meet your goal? Right Now I... Have the financial resources to invest in myselfI have access to the financial resources to invest in myselfI do not have any financial resources & I am going to stay where I am at I believe that working with a fat loss coach is a worthwhile investment YesNo If someone advised me to spend $1,000 on a coach to get me to my goal, help me through my struggle, have confidence in myself again, and live a happier/healthier life I would... Know it's what any person who has reached their goals and stayed there has doneWould be a little intimidated yet with a proven system I would do it because I'm serious about taking back my lifeWould not invest in the money in myself at this time I WILL CALL YOU AT THE TIME YOU CHOSE. PLEASE COMMIT TO YOUR APPOINTMENT TIME BY TYPING THIS SENTENCE IN THE BOX BELOW: "YES I PROMISE I WILL ANSWER THE PHONE FOR MY BREAKTHROUGH SESSION!" Finally, What's the single most authentic thing about YOU?