RECLAIM Application Form
Apply to learn more about the full RECLAIM program, starting February 12, 2019!

RECLAIM is a 6-month, intensive small-group coaching program to help you change the way you eat for good--so you can live happily without worrying about slipping from your diet. This is NOT a program to determine specifically which foods will help a particular condition or to treat symptoms. The cost of the program is $300 per month for 6 months, or $1500 if paid in full.

1. Full Name *
Your answer
2. Email address *
Your answer
3. Telephone number (IMPORTANT: this call will be from a private number, so your telephone must be able to accept it. If not, please let me know so that we can meet via Zoom online instead). *
Your answer
4. What is the hardest part of sticking with your healthy diet? *
Your answer
5. Are you comfortable and willing to share your personal challenges and your own feedback openly and honestly with others in the group? *
6. The meetings will take place on Tuesday evenings at 8:00 PM EST, twice per month from February 12 to July 2019. Are you able to commit to at least 80% of these meetings? *
7. How would you rate your own commitment to transforming the way you eat for life? *
I'm not really motivated
I'll do whatever it takes
9. Is there anything else you'd like to share?
Your answer
Thank you! If the program seems like a good fit, I'll be in touch soon to schedule a short call.
Your answer
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