Trigger Mapping BJFH GANG Questionnaire Form

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Due to a high volume of inquiries, we only have a few spots left in the program. Please understand that our team will review this form and proceed with a consultation if the application meets the basic requirements of the program.
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Where Did You Hear About Us?* This field is required.
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What goals are you hoping to accomplish in the next 6-9 months? Why is that important to you?* This field is required.
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What is it you expect to BE different in your life when you reach that goal?* This field is required.
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How do you expect to FEEL differently when you reach that goal?* This field is required.
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What do you feel has been holding you back from achieving this outcome successfully up until now?* This field is required.
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What have you tried in the past to achieve these outcomes that felt good or that you felt worked well?* This field is required.
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Are there any other obstacles you anticipate may prevent you from being successful while we work together?* This field is required.
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When do you currently feel the best about yourself and your nutrition? Please describe these moments emotionally and visually.* This field is required.
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On a 1 to 10 scale, how dissatisfied are you with your current state?* This field is required.
10 - Completely dissatisfied
1 - Not dissatisfied at all
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10 - Completely dissatisfied
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When do you feel the most triggered by food or disempowered in your mind and your body? Please describe these moments emotionally and visually.* This field is required.
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How do you normally react (in the actions you take and/or emotionally/mentally)when you feel this way?* This field is required.
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Do you have previous experience working with a coach? If so, what did you enjoy about that experience and what did you dislike about it?* This field is required.
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An offer will be made to join the Gang ONLY if we are able to help you! Do you agree?
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What role do you hope for me to play in your journey if we decide to work together?* This field is required.
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Your Name* This field is required.
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