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Worksheet

Delish Diet Breakthrough Intake Questionnaire

This form is to help me get to know you better, so that we can make the most of our time together!

1. ➜

First Name

2. ➜

Last Name

3. ➜

E-mail Address

4. ➜

Phone Number

5. ➜

What is your occupation?

6. ➜

Tell me a litte bit about your past struggles with weight loss.

7. ➜

What have you attempted in the past that didn't work? Why do you think it didn't work?

8. ➜

What is your biggest burning question when it comes to permanent weight loss?

9. ➜

Why is it important for you to release the weight now?

10. ➜

Anything else you would like me to know?

11. ➜

What is it about the Delish Diet approach that resonates or makes the most sense for you?

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