First Name *

Last Name *

Email Address *

Phone Number *

How did you hear about me? *

I work with women who are smart, highly motivated and have success in other areas of their life, like family, relationships and/or career. They already know what they should be eating, but they can't seem to figure out this whole "body thing". THEREFORE: Select which of these best describes you: (please select all that apply) *

Using food to cope, soothe, and escape your busy, stressful life is holding you back from reaching higher levels of success in your personal and professional life.

You are successful in so many areas of your life except this most sacred one with food because you’ve never been taught healthy, doable ways to manage and move through difficult thoughts, feelings and experiences.

Your emotional eating is a secret that you’ve been harboring for years and now more than ever, you want to be free.

You value high-level support and intuitive coaches so you can breakthrough your own inner glass ceiling

What challenges/obstacles are you currently facing in any of these areas: Overeating, Emotional eating, Weight, habits, self-esteem, body image, eating habits, self-sabotage, relationships, energy, mood swings, etc... *

How often are you struggling with the above challenges and obstacles? *

Everyday

3-5x a week

Less than 3x a week

Just a few times a month

How are these challenges and obstacles with food and your body holding you back in your life? (Think day-to-day: how it impacts your energy, self-esteem, love/sex, career success, finances, social life) *

Please list and describe what you have tried in the past to get to the bottom of this, heal your overeating and have a healthy relationship with food. and your body? *

What are your chief goals and desires? What do you REALLY WANT for yourself? *

Why do you think you haven't reached your goals or desires yet? What's getting in the way? *

How many times have you tried to solve this problem and failed? Why? *

What are you secretly afraid may happen to you if your sabotaging habits continue? *

Working with Audra is by APPLICATION ONLY, and there's usually a wait list. Please describe why you'd be a GREAT fit to work together. *

What would you like to see happen in 6-12 months with your behaviors, health, and body? What are you hoping to gain from working with Audra inside this program? *

Have you ever worked with a private coach or a coaching team before? *

Yes. I have worked with coach who was an emotional eating specialist.

Yes, but on a different area of my life (i.e.: life coach, career coach, business coach)

No.

I'm not 100% sure what a professional coach does or how they could help me.

Do you read self help books? If so, list your top 3 *

When it comes to FULLY committing to your desire to heal your emotional eating, health, body image, weight and body struggles, what's getting in your way? (please select all that apply)*

I'm afraid no matter what I try, I'll fail

Getting the support I need is too expensive

The process to heal will be more painful than the "food jail" and "body hell" I'm currently in

I feel like I'll have to live with this forever, so what's the point in trying

I don't have support and accountability

I don't know what to do

I don't want my friends or family finding out that I need help

Have you ever invested in yourself, your health and/or wellness? *

Yes

It is NOT traditional nutritional health coaching. And it is not structured like simple life coaching or therapy sessions. These programs are reserved for those who want peace with food, body and mind more than anything. These powerful life changing programs are an alternative approach specifically designed to heal your relationship with food physically, mentally and spiritually with real results that last a lifetime. THEREFORE: the investment of time, energy and resources is significant. Is this in line with the level of support you are ready to receive and investment you are ready to make? *

Yes. If I feel called to this alternative to healing my relationship with food once and for all. When I want something, I'm willing to make it happen.

Maybe. I don't have much faith in my ability to succeed because I've tried so many times and failed. I'm scared to be fully committed, especially financially, because I'll just fail again.

Maybe. I am interested in learning more & need to know pricing to see if it's even something I can even begin to afford because there are limitations.

No. I'm looking for one-on-one sessions and just need a few to set me straight.

Please check which of these best describes your willingness to invest in healing the deeper reasons you reach for food to cope: *

Very willing; I will do whatever it takes to learn how to break free from this hell

Pretty willing; I know it is worth it to invest to receive high-level support, but I am scared

Somewhat willing; I hold judgements about mentoring programs, but I know I need the support

Not willing at all; I feel completely resentful of being asked to invest in myself especially since you are here to help people

In making the decision to invest in support around this, are you the sole decision maker? Or would someone else be involved in the investment decision? If so, who would that person be? *

Anything else you'd like Audra to know? *

Final Note -

I understand that by filling out this application, I'm applying for an exclusive spot in Hello Body Freedom Coaching with Audra Baker, and have the time and money to dedicate to a program like this.

Permission to Contact *

I give you permission to be on Audra Baker's mailing list.

Hello Body Freedom Application