Work With Me
Thank you for your interest in working with me. This questionnaire gives me insight into the kind of support you're looking for on your health journey, and I appreciate your openness and honesty in filling it out! What happens after you hit submit? There are no obligations — if it feels like a good fit, I'll reach out within 3 business days to get the conversations started and for us to learn more about each other. I'm looking forward to meeting you!
Phone number (type in 'Zoom' if outside the US)
What time zone are you in?
Are you able to be available at some point Monday–Friday between 9–5pm ET for appointments?
How did you find my corner of the internet? (Referred by a friend, Instagram, podcast, etc.)
What is your age?
Describe your biggest health challenge, and please mention any chronic illnesses.
What have you already tried to resolve these problems? Have you worked with another practitioner in the past? If so, please let me know what you liked and disliked about the experience.
How are these issues holding you back in your personal and/or professional life?
What has your relationship with food been like throughout your life?
Why is now the right time for you to address these issues?
What does support look and feel like for you right now?
I like to connect with you so we can see if we're a good match for each other, and for you to see if this feels like the support you need and want for your health. How would you like to connect?
I would like to schedule a quick call to get a better feel about how coaching would work.
I would prefer to chat over text/voice memo.
No need for a call, I'm ready to do this!
If you chose a call or text/voice memo, please leave your phone number, Instagram or Voxer handle:
Have you budgeted for this investment in yourself?
Yes! I'm fully ready to invest in coaching.
Yes, but may need to take advantage of payment plan options.
This may be a stretch for my budget but I'm willing to make it work.
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm