The Mindset Questionaire

Fill out this questionnaire for some self-reflection to see if your mindset is what's holding you back. At the end you'll have an opportunity to book a free mindset discovery call with Dana Lee to talk about the MindFit Mentorship and whether private coaching could be what will resolve emotional, binge and compulsive eating and other dysfunctional behaviors once and for all.

Click the button below to begin.


Question 1 of 13

Today's Date:

Question 2 of 13

First and Last Name:

Question 3 of 13

 Your Best Email:

Question 4 of 13

How did you hear about Dana or come to know her? (YouTube? Facebook? Through mutual friend? Did you work together in the past? etc)

Question 5 of 13

How long have you struggled with food?

Question 6 of 13

What is causing you the most pain and anguish right now regarding your behavior with food? (ex: binge eating, emotional eating, night time snacking, obsession about food rules, having food fear, body image etc)

Question 7 of 13

Check all that you can identify with:

(Select all that apply)

I've been in a lengthy battle with the bathroom scale.


The number on the bathroom scale can affect my mood or sense of self-worth.


I believe I'll finally be happy and love my body once I reach an "ideal" bodyweight or specific body measurements.


I can't remember the last time I wasn't trying to lose weight.


I think it's important to finish every workout feeling totally exhausted.


I've performed workouts as punishment for overindulging or skipping a workout earlier in the week.


I've performed a workout to "earn" the right to eat dessert or my favorite meal or second helping.


I determine the value of a workout based on how sore I am the next day.


I've been "hating my way" to a lighter/leaner/shapelier body (i.e., you think disliking parts of your body you want to "fix" is good motivation to work hard).


Activities I once did for enjoyment (biking, going for a walk, hiking, jogging) are now activities I make myself do solely for the calorie burn.


I wish I knew what it was like to look forward to and enjoy my workouts.


I want my workout regimen to help me feel good about myself.


I've never known any reason to strength train or move a my body apart from the calorie burn or fat-loss potential.


I crave a change of pace, a proverbial "breath of fresh air" with my food plan and/or my fitness regimen.

Question 8 of 13

On a scale of 1-5 (1 being I'M AWARE, BUT SCARED and 5 being HELL YES, I'M READY!) What stage are you at with your willingness to break free and create a brand new relationship with food?

Question 9 of 13

Often times mothers in particular, are in tremendous need of self care, support, community and a space to do their own work to heal and recover from dysfunctional eating. 


Are you willing to invest money, time and attention in yourself at this stage of your life? (especially knowing that when committing to this work, EVERYONE around you benefits)

Working with Dana requires a financial investment in yourself along with a time commitment. There is no obligation to enroll in one of the programs after this call, but it is important that you understand ahead of time for your own consideration.

(Select all that apply)

Yes, although I am a mother, I do understand, and I am ready to discuss my options.


No, I don't think I can begin putting myself first yet.


Although I am not a mother I can still see how I often put others before me. Yes, I AM ready to address these issues.


My finances have me concerned about not being able to get the help I need. I would be interested if there were an option that suited my particular budget.

Question 10 of 13

Is there anything else you'd like to share?
Or, do you have questions for Dana Lee to answer for you?

Question 11 of 13

Name 3 days/times (include your TIME ZONE) that work best for your schedule over the next week or so. This will make coordinating a time for the zoom call easier! (unless we already booked an agreed upon time, you can just confirm that below.)

Question 12 of 13

My time and your time is to be valued. Communication and commitment is to be valued.


Should you need to reschedule once we set the date, we can do that as long as you let me know in advance (via email or FB messenger if we are connected on Facebook)


IF HOWEVER, the appointment is a "no show" or it is "forgotten" about, unfortunately we will NOT be able to reschedule.

Please be sure to check your spam folder for correspondence from [email protected]


Thank you for acknowledging by checking the box below:

(Select all that apply)

I Understand

New Question

Confirm and Submit