Clone of Work with Georgie

1

First, let's get acquainted and start with your name* This field is required.

First Name

Last Name

2

Nice to meet you , what's your email address?* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Are you based in Australia?* This field is required.

YESNO

5

Where are you located?* This field is required.

6

How long have you been following Georgie for?

I'm Brand New

I've been following Georgie for awhile

I've been around for a long time!!

7

Have I completed Georgie's 3 Month Intensive (previously known as NBT) Program Before?

YESNO

8

Have you had Weight Loss Surgery or are Weight Loss Medications?* This field is required.

YESNO

9

Did you make it to goal weight?* This field is required.

YESNO

10

Please detail what Weight Loss Surgery Or Weight Loss Medications You're Taking

11

How far away are you from your goal weight (use kgs/pounds or dress size)* This field is required.

12

When it comes to eating and weight, what has been/continues to be your single biggest struggle and how does this affect your day-to-day life? (physically and emotionally)* This field is required.

13

What does a life of freedom around food and your weight look like? How would life be different for you?* This field is required.

14

If you don't take action at this point, what do you think might happen in relation to your eating and weight? What are you most worried about?* This field is required.

15

Do you have any mental health challenges or diagnosis (e.g. bipolar, borderline personality disorder etc). Please provide some context below.* This field is required.

16

Do you have any mental health challenges or diagnosis (e.g. bipolar, borderline personality disorder etc). Please provide some context below.* This field is required.

17

Have you been in therapy before? Have you worked on eating and weight in therapy?

18

Will You Be Using The Following To Claim Sessions In Georgie's Program* This field is required.

Medicare Plan

NDIS

Private Health

I don't wish to claim

19

Are you looking for a life where you can (you can select multiple options)* This field is required.

Feel in control of your cravings?

Have real time advice and support from a Registered Psychologist & Coach when you have a craving or sabotage pattern who has 15 plus years.

Have effective strategies and tools that are backed by science and data (not just some fad that works in the short term) on controlling your eating and cravings.

Feel real freedom and heal your relationship with food in the longer term, and not feel consumed about food 24/7

20

Please take your time to read through these details, make your selection and then click SUBMIT* This field is required.Are you wanting to work with Georgie in her Intensive for 3 months? The investment to work together starts at AUD$478 per month with rebates (Eating Disorder Plan or a Mental Health Care Plan). If you are overseas it starts at USD$400 per month. Are you ready to invest in solving your cravings and weight regain issue to experience natural control and natural weight loss?

Yes, I'm SO ready.

Yes, finances are limited, but I can make this work on the payment plan

No, I'm not ready to invest right now