BAM PROGRAM
Are we the right fit? Let's try this on...
Name
*
E-mail
*
Contact Number
-
Area Code
Phone Number
What is your relationship to your body and weight?
Describe your relationship with food including current and relevant history.
What would your life be like without those challenges?
How has our culture influenced this struggle for you?
Please list any therapies or supports that you have in your life. What else have you done to support this issue or your health in general?
Where do you feel the most resistance to making change?
Why NOW?
How willing are you to make changes on a scale of 1-10 ?
1 = my mom is filling this for me. 10 = fuck yes
Are you truly ready to make a financial, emotional, transformational commitment to yourself?
Yes
No
Maybe
Questions? Anything else to share?
Submit
Should be Empty: