Name
First Name
Last Name
Email
example@example.com
What would you like to accomplish by working together?
Are you 18 or older?
Are you currently pregnant or nursing?
Do you live in the US, or elsewhere?
What is most important to you when working with a practicioner?
Which providers have you worked with in your health journey? Did they provide the support you were looking for?
Do you have a history of disordered eating? If so, do you have a good relationship now?
Are you willing/able to make changes to your diet?
What is your gender?
What is your ideal timeline for starting to work together toward your goals?
I understand that Lissette is a registered dietitian and HTMA Practicioner. I understand she is NOT a therapist, personal trainer or doctor. I understand the information inside this program is for educational purposes only, and should not be used to delay or as a substitute for medical advice, diagnosis, or treatment.
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