RECLAIM Application Form
Apply to learn more about the full RECLAIM program, starting October 1, 2019!

RECLAIM is a 6-month, intensive small-group coaching program to help you shift the way you eat and think about food so that you can enjoy true food freedom and live a full and happy life without slipping up again.
1. Full Name *
Your answer
2. Email address *
Your answer
3. Telephone number *
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. 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
7. What about the RECLAIM program is most interesting to you?
Your answer
8. The meetings will take place on Tuesday evenings at 8:00 PM EST, twice per month from October 2019 to March 2020. Are you able to commit to at least 80% of these meetings? *
9. Is there anything else you'd like to share?
Your answer
Thank you! I'll be in touch soon to schedule a short call.
Your answer
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