Luscious Living Application

Luscious Living Application

Welcome! Please complete this application to help Selin learn more about you:
Contact Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Occupation
Age
How did you hear about Selin?
Your Goals
What is your primary health goal right now?
Examples: lose 15 lbs, improve energy, balance hormones, reduce digestive symptoms. Please be specific and include measurable targets if possible.
How long have you been navigating this issue?
Examples: weeks, months, or years (e.g., 6 months, 2 years).
What have you already tried to address this issue? What worked and didn't work?
Examples: working with a doctor and/or naturopath, seeing a dietician, calorie counting, elimination diet, supplements, therapy, medications. Please be specific about duration and adherence.
What made now feel like the right time to seek support?
Examples: recent diagnosis, pregnancy planning, plateaued progress, worsening symptoms. Please be specific about triggers or timing.
Health Background
Please list any diagnosed medical conditions
Examples: hypothyroidism, PCOS, IBS, diabetes. Include diagnosis date if known.
Please list your current medications and supplements:
Examples: metformin 500mg daily; fish oil 1000mg daily; vitamin D 2000 IU. Include dose and how long you have taken them.
Readiness & Commitment
Can you tell me about any challenges, barriers, or circumstances that have made it harder to achieve your goals? What kind of support would feel most valuable to you right now?
Examples: lack of time for meal prep, emotional eating, limited budget, family schedule. Please be specific and give examples.
How committed are you to implementing recommendations and making changes?

1

2

3

4

5

6

7

8

9

10

1 is Not committed, 10 is Fully committed
Why did you choose the number above? And, if your current health concerns remained unchanged over the next year, what impact do you think they would have on your quality of life?
Examples: continue weight gain, persistent fatigue, worse digestive issues, no progress toward health goals. Be specific about likely consequences.
Agreement
I understand that Selin is a holistic nutritionist; her services are educational in nature and do not replace medical care.
I confirm that the information I have provided is accurate to the best of my knowledge.
Signature
How Sessions Work

This is the vibe...
Selin’s approach is centered on practical, sustainable nutrition and lifestyle strategies that fit into your real life...not a one-size-fits-all plan.

Recommendations are thoughtfully tailored to your goals, preferences, needs, and daily routine, with an emphasis on creating changes that feel realistic, manageable, and sustainable over time.

The goal isn’t perfection - ever! It’s helping you build habits that work for you and can grow with you.

Why I Do This Work
My work with women’s health is deeply personal and about so much more than nutrition. It’s about helping women feel empowered in their bodies, supported in their health, and confident in the steps they’re taking toward feeling better.

For many women, that journey can look like digestive symptoms, changes in weight, low energy, hormonal changes, or simply feeling like the things that used to work no longer do. I know this all too well, and my own experiences shaped the way I approach nutrition today.

I help women understand the connection between hormonal health, digestive health, nutrition, and sustainable weight management, while recognizing that every woman’s body and story is different.

My approach focuses on practical, sustainable strategies that fit real life - not with more rules or a one-size-fits-all plan. I believe women deserve support that looks at the whole picture, not just a number on the scale or a single symptom. Whether you’re navigating hormonal changes, digestive concerns, working toward sustainable weight loss, or simply feel like your body needs a different approach, you don’t have to figure it out alone.
Depending on the service or package you choose, your support may include:
- Comprehensive nutrition assessment as a thoughtful look at your nutrition, lifestyle, and overall wellness.
- A review of health history and current concerns
- Personalized nutrition recommendations so that you receive practical, realistic guidance tailored to your individual needs and goals.
- Written action plan with clear next steps to help you turn what we discuss into meaningful, manageable action.
- Educational resources and handouts to support you between sessions.
- Email support between sessions included for clients enrolled in the 3-Session Kickstart Package, providing additional support for questions, clarification, and staying on track between appointments.
The goal is to leave each session feeling more informed, supported, and confident about your next step.
Please note that Selin’s work is educational and supportive in nature, with a focus on helping you better understand nutrition, lifestyle, and the factors that may support your overall well-being.

Selin does not:
- Diagnose medical conditions
- Prescribe medications
- Replace your physician or healthcare team
- Provide emergency medical care
- Guarantee specific outcomes or results
- Any nutrition or wellness recommendations provided are intended to support your overall health and well-being and are not a substitute for individualized medical advice, diagnosis, or treatment from your physician or qualified healthcare provider.
If you have a medical concern or are experiencing symptoms that require medical attention, please consult your healthcare team.
Fees & Session Options
All appointments are conducted virtually via secure video conferencing.

Each session is designed to give you clarity, structure, and a clear next step.

Discovery Consultation: 30 minutes
$60 + GST

A focused session to clarify your main concern, assess fit, and identify the best next steps for you.

Initial Consultation: 60 minutes
$235 + GST

A comprehensive assessment of your health history, symptoms, lifestyle, and goals, followed by a personalized nutrition strategy designed around your needs.

3-Session Kickstart Package: 60 minutes + 2 x 30 minutes
$425 + GST (Save $70)
An excellent option if you’re ready for more comprehensive support, with time to assess, personalize, refine, and build accountability along the way.

There’s no need to have everything figured out before you begin. We’ll meet you where you are, help you understand what your body needs, and take it one step at a time. 💛
What Happens Next!
You’re officially on your way! We are so excited to support you on this journey and help you create a healthier, more sustainable approach to your nutrition and well-being. 💛

Here’s what you can expect next:
- A team member will reach out to schedule your first session and find a time that works well for you.
- You’ll receive a deeper health intake form along with our Services Acknowledgement. This helps us learn more about you, your goals, your health history, and how we can best personalize your experience.
- You’ll receive your invoice with the details for your services.
- You’ll receive a calendar invitation once your session is scheduled, so everything is in one easy place.
That’s it for now - we’ll guide you through each step along the way. Take a deep breath, celebrate taking this first step, and know that you’re in good hands.

We can’t wait to get started with you!
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Luscious Living Application

Contact Information

Your Goals

Health Background

Readiness & Commitment

Agreement

How Sessions Work

Fees & Session Options

What Happens Next!