Mindfully Well Program

Hey Friend!

Thank you for your interest in Mindfully Well. Let's see if this program is the right fit for you. This assessment will take approximately 15 minutes to complete. Please use thorough answers and take your time to think about and complete these questions.


Click below to get started.


Question 1 of 11

What is your first and last name?

Question 2 of 11

What is your email?

Question 3 of 11

How did you hear of Melissa Eich Coaching?

Question 4 of 11

Tell me why you're interested and what you hope to achieve in the Mindfully Well program. 

Question 5 of 11

What is your current biggest struggle when it comes to your health/or weight?

Day to day..what do you struggle with? Look outside of your circumstances here (work, kids, schedule etc)

Question 6 of 11

Tell me about your past dieting history.

What programs have you done? Why did they work or not work? Did you love something about them or did you hate them? Why do you believe they worked or didn't? 

Question 7 of 11

What's your ultimate goal?

Let's think about your future one year from today. You've reached your goal...what is that goal? You can pick anything and don't play small. What do you really want and why do you want that?

Question 8 of 11

What changes in your life when you reach that goal?

Think about everything here. How do you show up? How do relationships change? Does this affect your family or your work?

Question 9 of 11

This program requires stress management.

Are you willing to do the work (with my help) around your stress to help heal your body and lose the unwanted weight? 

Question 10 of 11

Do you have any current health diagnoses or conditions? Please list them. 

Question 11 of 11

 Coaching with Melissa requires you to look inward, face adversity with yourself, and feel uncomfortable emotions while continuing on - (with my support and lovingly holding space for you, of course). 

This is not a nutrition-only program - this is a finding the root cause of your presenting problems and solving for it - type of program. (hint, it's not just a dietary thing;)


Is this something you are willing to do?

Confirm and Submit