2024 Coaching Program Application

2024 Coaching Program

Complete this Clarity Call application before your appointment so we can discuss your weight and diabetes transformation. First, we’ll look at what you’ve already tried to solve this problem and identify how you want things to be different in the future.

- Coach Linda

Name

First NameLast Name

Email

example@example.com

How long have you been struggling with diabetes and weight issues?*

1-5 years5-8 years8-15 yearsOver 15 years

On a scale of zero to 10, how important is it for you to lose 20 pounds in six months?*

What have you tried to lose weight?*

What other health areas do you want to improve and why?*

Have you tried to lose weight on your own?*

YesNo

Are you ready to take control of your weight now?*

YesNo