* PLEASE READ FIRST *
HELLLO + WELCOME! I could not be happier that you decided to finally make the leap and take control over your mind, body + blood sugars. Keeping it 100 is my signature 8 week program that includes high level accountability. It offers WEEKLY group coaching calls, BI-WEEKLY 1:1 strategy calls with Lissie, and EXCLUSIVE video modules that will change your lifestyle in a sustainable and integrative way. To make sure this is the right fit for you, please fill out the application below and book a 15 minute phone call at the end! I can't wait to speak with you!
YOUR NAME:
First Name
Last Name
YOUR EMAIL:
example@example.com
INSTAGRAM HANDLE:
PHONE NUMBER:
-
Area Code
Phone Number
REFERRAL (if applicable):
WHAT WAS YOUR LAST A1C?
WHAT IS YOUR GOAL A1C?
TELL ME ABOUT YOUR HEALTH GOALS - WITH OR WITHOUT T1D:
WHAT IS YOUR #1 GOAL YOU'D LIKE TO ACCOMPLISH IN THE NEXT 8 WEEKS?
WHAT ARE YOU MOST FOCUSED ON RIGHT NOW?
Lowering my A1C
Increasing my insulin sensitivity
Exercising with T1D
Improving my nutrition with T1D
Improving my relationship with T1D
WHAT IS YOUR CURRENT DAY TO DAY? DO YOU WORK FULL TIME/PART TIME/STUDENT?
ANY QUESTIONS YOU'D LIKE LISSIE TO GO OVER ON OUR CALL?
The demand for this program is high. Lissie can only work with 10 individuals to give the highest quality of support and value. Are you ready to commit?
Hell yes!
I'm not ready to commit to my health goals
You're almost done! Don't forget to book your consultation call at the link below:
https://calendly.com/needlesandspoons/keeping-it-100
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