Love Your Body Intro Assessment If you are a human and are seeing this field, please leave it blank. First Name Last Name Phone Email State of Residence Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming What days and times work best for you to meet? What inspired you to enroll in this program? Are you currently being treated for an eating or body image disorder? If so, explain. Do you feel that you currently have an eating disorder, but are not receiving treatment? What is your ideal relationship to your body? What stands between you and your ideal relationship with your body? What does it mean, to you, to love your body? List your top 5 strengths or talents What inspires & energizes you?