Lose Stubborn Weight With The Body Back Blueprint

Please fill out the application to see if we are a good fit!

This application helps us determine if this coaching program is the best fit to support you in reaching your goals. If it feels like a match, you’ll be invited to book a free consultation so we can map out next steps together.

Please answer honestly and completely—your answers are confidential.

Full Name *

Your Best Email *

Phone

What are your top 3 health/weight goals for the next 90 days? *

Why is achieving these goals important to you, both in your day-to-day life and in the bigger picture of who you want to become? *

If that obstacle disappeared in the next 30–60 days, what would feel different in your life, body, or confidence? *

What's the biggest obstacle that's holding you back from reaching your goals so far? *

Medical Conditions? *

Do you have an eating disorder? *

Not diagnosed but maybe some disordered eating

Yes - diagnosed

What phase of menopause best fits where you are? *

Early Perimenopause

Late Perimenopause

Post Menopause

What kind of support do you most need right now? (Select up to 2) *

This coaching program is a high-touch experience and requires a financial investment of at least $650/month or more and a 3 month commitment. Knowing that my method can fully support you in losing weight without restrictive diets, are you ready to make the financial and time commitment? *

I'm ready & able to invest in myself!

I'm ready to invest, and I'd need a flexible payment plan to make it work

I do not have the ability to invest right now but I’d like to work with you in the future

If you're accepted into the program, when would you want to get started? *

Right away!

Within the next 4-6 weeks

I'm not ready anytime soon

9. Are you ready to make a confident decision now if it’s a great fit? If you're invited to book a free consultation, are you committed to showing up fully prepared, having already talked to anyone who needs to be involved in a financial decision (partner/spouse)? *

Yes – I’ll be ready to decide, and I’ve already had that conversation

Yes – I commit to having that conversation before the call, so I’ll be ready to decide

No – I haven’t talked to anyone yet and would not be ready to make a decision on a call

10. Is there anything else you’d like to share about your health journey or your desire to be part of this program?

SMS Compliance Agreement Statement

By providing your phone number, you agree to receive text messages from Hēla Functional Nutrition, also known as Rachel Wood. Message and data rates may apply. Message frequency varies. Reply STOP to Unsubscribe. Be sure to add this number to your contacts on your phone so you can text me anytime.