Eating Freely Pre-Assessment
Questionnaire

Thank you for completing this questionnaire, which is personally reviewed by Emma Murphy, our founder. It will help Emma get to know you a little better and ensure you are matched with the best Eating Freely Practitioner for you!

This questionnaire should take around 10 mins to complete

Blank Form (#14)

First Name

Please select your country

County/State/City

Please let us know your age

Are you comfortable working online with a practitioner?

Yes

How long have you been struggling with food, your weight and/or your body image?

If I could wave a magic wand, how would you like your life to look like in 12 months’ time?

How would YOU describe your problem?

Have you sought help with this before?

Yes

If you answered 'Yes', can you tell me what type of help, for how long, and if you felt it helped or not?

..and if it didn't help, why do you think it didn't?

On a scale of 1-10, how motivated are you now to truly tackle and overcome this issue?

What would it mean to you to overcome your struggle with food, emotional eating and body image and move on with your life, free of all the stress associated with this issue?

Finally, is there anything else you would like to add for me to see ahead me matching you with an Eating Freely Practitioner?

Preferred method for contact:

Text message

WhatsUp

Mobile Phone Number

Eating Freely Pre-AssessmentQuestionnaire

Eating Freely Pre-Assessment
Questionnaire