Application for Nutrition Coaching Welcome! Please take a few moments to let me know about yourself. I will email you to schedule a discorvery call & determine if you are a good fit for my private coaching. Full Name Email Phone Number Instagram Handle What state do you live in? If you don't live in the United States, what country? How did you find me (Facebook, Instagram, friend, etc.)? What is the main goal you hope to achieve from working with me? What are your biggest struggles with food, health, and/or your body? Do you currently have a diagnosed active eating disorder? If yes, do you have a therapist? I do not work with minors currently. Are you 18 years or older? Yes No Do you have any reservations about working with a dietitian? If so, please list them here! Is there anyone else involved in the decision making process that needs to be involved in our call? What health insurance plan do you have? If no health insurance plan, please write N/A. If your health insurance plan does not cover the cost of nutrition counseling, are you willing to pay out-of-pocket? Yes No If we decide we are a good fit to work together, will you be ready to start in the next 30-60 days? Yes No Submit
