Escape From Emotional Eating
Focused Action Accountability Form

I’m looking forward to our next session together! Please be sure you are fully present and connected to yourself while honestly answering these questions.

Please submit your form no later than 24-hours prior to your next session to ensure Jessica has time to review and prepare for your call. 

Know that your transformation starts as soon as you submit this form. So don’t be alarmed if you received inspired ideas, your behavior changes, or you experience unexpected miracles between the time you submit your form and the time we connect! That’s the power of this process 🙂 

All responses are kept confidential and go directly to Jessica.


  • Note: The definition of emotional eating means using food for a purpose other than fuel (like numbing, procrastination, distraction, escape, even digesting happiness.) Emotional Eating also means you were eating with abandon of all Hunger & Fullness levels.
  • This field is for validation purposes and should be left unchanged.
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