Is HA Coaching Actually right for you?

Do you have lab work within the last 1-12 months (reproductive hormones) that you'd like us to review?

Reproductive hormones mean: Estrogen, LH, FSH, Progesterone, Testosterone, Prolactin

Yes

No

What is your current relationship with food like? *

Disordered eating

History of eating disorder

Recently exited an ED program and ready/willing to make changes to food & exercise habits

Active eating disorder, working with an ED team

Other

Symptoms and Behaviours Check List

Low libido

Brittle hair, nails or hair loss

Stuck in a "restrict - wanting to heal - restrict" cycle

Do you try to incorporate rest days but keep finding way to be “stay active”?

Do you tell yourself that you’re going eat more but then find yourself not doing it?

Are you body checking?

Do you find yourself making excuses for why you need to keep your exercise habits?

Do you find yourself incorporating high amounts of vegetables/lean proteins/diet foods even though you're trying to recover?

Your Name *

First Name

Last Name

Phone

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Country

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