Health Snapshot Use the quick form below to define some of your most pressing health challenges. First Name * Last Name * Email * Phone * Please check off the issues that pertain to you: Emotional Eating Binge Eating/Drinking Food Cravings Excessive Weight Fatigue/Sluggishness/Low Energy Hormonal Issues Asthma/Bronchitis/Sinus Problems Indigestion/Bloating Poor Memory/ Concentration Anxiety/Fear/Nervousness Anger/Irritability Depression/Guilt/Shame Frequent Illness Perfectionism Joint Pain Diabetes Risk On a scale of 1-10, one being the least, please rate the following: It’s important for me to feel great and be the best I can be. * Please select one12345678910 I am interested in improving my health and energy. * Please select one12345678910 I am ready to commit to achieving my wellness and weight goals. * Please select one12345678910 I am willing to invest time and money in myself. * Please select one12345678910 As soon as you submit your Health Snapshot, you will receive comments and suggestions from me within 24 hours to help you arrive to an easy, workable solution to solve your most pressing health and weight issues. Looking forward to receiving it! Take care, Roberta Submit