New Client Wellness SupportAre you ready to embark on a journey of self-improvement? Get on the waitlist today. Apply today to get on the waitlist. Name * First Name Last Name Email * Phone (###) ### #### How did you hear about me? * What are your goals in working together? * Please describe past experiences in reaching your personal wellness goals? * What have you tried? Please tell me about your current challenges. * Are you coachable? * Yes No What would the optimal result or outcome be if we were to work together? * Is your family or those within your household supportive of you changing your lifestyle? * Yes No Not applicable Is there anything else you would like to share with me that you feel is important for me to know about you? * Are you under the direct care and supervision of a medical doctor for a disease or medical condition requiring nutrition intervention? * Yes No Are you aware that I am not a licensed physician, medical doctor, dietitian, licensed dietitian, registered dietitian, nutritionist, licensed nutritionist, nutrition counselor, or licensed nutrition counselor? Are you aware that I am not implying that I am dietitian, nutritionist, or nutrition counselor? * Yes No Are you willing to make the necessary lifestyle changes required to meet your personal wellness goals? * Yes No Thank you! I will be in touch with you within 48 hours.
