Form Page — Dori M

I’m looking forward to meeting you and learning more about how I can help!

Please answer the questions below. You’ll receive the link to schedule our free 30-minute call together once you submit this form.

Name

First Name

Last Name

Age

Sex

(Note: I’m not just being nosy – age and sex factor into your cravings triggers!)

1. How long have you been struggling with stress and cravings?

2. How have cravings and binging affected your quality of life, financially and healthwise?

3. How often do you have cravings? Please choose one:

4. What time(s) of day do you experience cravings most often? You may choose all that apply:

After breakfast

Afternoons

After dinner

In the middle of the night (such as 2-3am)

5. What have you tried to help with your cravings in the past? Which of those seemed to work best?

6. What is your biggest obstacle to beating cravings?

7. There are 5 reasons people commonly want to end their cravings: Lose weight and eat healthier; Get rid of gas and bloating; Boost energy and brain function; Decrease muscle and joint pain; and Improve sleep. Please list these 5 reasons below in order of importance for YOU, with the first reason as the most important and the 5th reason the least important.

8. Are there any other reasons more personal to you that you are motivated to end your cravings?

9. On average, how many cups of water are you drinking daily?

10. Are you usually full after regular meals? Please choose one:

11. What are your meal times?

12. Please describe your sleep habits (hours, duration, and quality):

13. What foods do you typically crave? Do you prefer salty, sweet, or a certain texture such as creamy or crunchy?

14. How important is it for you to ditch cravings for the long haul?

A quick note: In addition to managing a busy coaching practice, I am a wife, mother, daughter, sister, and friend. I love my work and am over the moon about getting to know you! However, please only submit this form if you are serious about showing up for our free call together and taking better care of yourself.

If that doesn’t sound like you right now, I totally understand. Please join my community by providing your name and email below. I’ll send you tips and encouragement to stop your cravings, and you’ll know where to find me when you’re ready!

I’m looking forward to meeting you and learning more about how I can help!

Please answer the questions below. You’ll receive the link to schedule our free 30-minute call together once you submit this form.

You belong here. ♡