Connection Call Form Name * First Name Last Name Email * Phone number * Date of birth * MM DD YYYY If located outside of the U.S., I understand that we will use Lillie’s Zoom link for our call. This link will be sent to you via email after your application is reviewed. * I agree I do not agree How did you hear about ilm yoga therapy? * Describe your relationship with your body and food. What does “here” look like? How does your relationship with food and your body impact your daily life, relationships, and personal well-being? * Describe to the best of your ability where you want to be in your relationship with your body and food. What does “there” look like for you? What would your life be like if you befriended your body, and looked to food as fuel? * What are the hurdles you will have to overcome to get from #1 to #2? Who or what is getting in your way? Include all self-sabotaging behaviors, beliefs, habits, etc. * What internal resources do you have to support you to transition from #1 to #2? What’s your support system like? * What have you tried so far to heal your relationship with your body and food? * What are you afraid will happen if you don’t heal your relationship with your body and with food? * How will you know when you have befriended your body? What will your daily life, relationships, and personal well-being be like? * What level of support are you hoping to get from Lillie? * I’m all in! I am ready to create lasting positive change in my relationship with food, my body, and my life, and I will allocate the resources to make it happen. I’m not sure. I want to feel better in my body, but I have a few questions first. I don’t have the time or energy to take action right now. Thank you!