BONNIE NOLAN

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BONNIE NOLAN

Email *

Birthdate *

YYYY

Height *

Approximate Current Weight *

Which of the following are true (or mostly true) for you when it comes to food? *

I have been on and off diets much of my adult life

I weigh myself more than once a week

I look at a meal and immediately guess how many calories or grams of protein, carbs, and fat it contains

I feel “safer” when I track all my calories and macros

I feel guilty and shameful when my will power is not strong enough to stick to my meal plan

I exercise to burn off calories I feel guilty about consuming

I often wait until I’m starving to eat, and then I end up overeating

I often say, “I already messed up by eating a few _____ so I may as well finish them all and start fresh tomorrow”

I often avoid social situations because I don’t want to be tempted by foods I’m trying to stay away from

I often eat while I’m working, watching tv, or driving

When I eat depends on when I think I should, not necessarily when I feel hungry

I often use food to comfort myself when I’m feeling down or stressed out

I use diet pills, metabolism boosting pills, or other weight-loss supplements

I often rush through meals, not paying close attention to how well I chew, or the flavors or texture of the food

Required

Which of the following are true (or mostly true) for you when it comes to your body? *

I often compare my body to others and end up feeling depressed or jealous

I “feel fat” most of the time

I often compliment other people’s bodies

I often miss, or have to fight myself to get to social events because of how I look

I “hate” certain parts of my body

I try to figure out how to change the way my body looks daily

I avoid being in photos as much as possible

I look in the mirror and see all my flaws immediately

I think about how happy I would be if only I liked how my body looked

I find myself pinching the skin on parts of my body to test how much fat there is

My feelings about my appearance often get in the way of me accepting myself or enjoying life

Required

Which of the following are true (or mostly true) for you when it comes to your emotional health? *

I get defensive, sad, and/or angry when criticized

I tend to put everyone else’s needs before my own

I have trouble creating balance in my life

I have trouble “letting go” of anger and resentment

I tend to disconnect from others and hide when I’m feeling down

I have trouble saying, “no” to people, and when I do say no, I often feel guilty

I consider myself a “perfectionist”

I consider myself an anxious person overall

I feel shameful about things that have happened in my life in the past

I stress about not having enough time

Required

The top 5 things I value in my life / in this world are... *

My greatest strengths are... *

The biggest hurdles keeping me from reaching my health and fitness goals are... *

The vision I have for myself and my life following my time working with Ella is... *

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