Please take some time to answer these questions. Be sure to be honest with yourself and with me. This will help me better serve you toward long term success.

Name *
Your main motive for this change is for your own reasons and not because someone else thinks you should.
You have more than one reason why you believe you want to change behavior (e.g. lose weight) which may positively impact your overall quality of life.
You do not believe you are capable of participating in the activities and tasks that are needed in order for you to make a successful change.
You are unwilling to make the commitment of time and effort needed to change your current behavior as your life is already quite stressful.
You will accept the fact that sustained success may be a slow and challenging process, yet you will continue your efforts despite that disappointment.
You are not prepared to be patient with yourself and will mostly give in or quit when you encounter obstacles, backlashes, or barriers.
You do not have support for this change from friends, family or loved ones.
You have never before tried to change this behavior or a behavior similar to this one.
You accept the reality that your ultimate success requires sustainable behaviors as opposed to temporary changes regardless of your rates of success.
You recognize that a structured and disciplined approach to making and sustaining healthier behaviors will be needed for indefinite periods of time to help you achieve the goal(s) you desire.
Please list at least 2.
Please list at least 2.
List at least 2 strategies that will help you be more successful in your opinion. Basically, what motivates you?
Please list at least 2 strategies that would cause you to be less successful. (e.g. If my trainer yells at me, I may not be inclined to work harder.)
I commit to the agreed upon plan set before me over a period of (4, 8, 12 weeks). *
I will not quit, even when I get tired and want to give up. I will endure the training under the advice of my trainer, Bekah Self. *