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Email *
First Name *
Last Name *
Phone Number *
Where are you located? (city/province/country) *
Let's get social! What's your social media name or handle?
How did you hear about me? *
If applicable, enter the name of the person who referred you:
What are your current challenges and struggles with food, nutrition and/or body image? *
What would you like to change in your next 3-6 months? *
On a scale of 1-10, what is your current motivation to make these things happen? *
Have you worked with or considered working with a dietitian before? If so, how was it? *
Do you have a significant other or anyone else involved in the decision making process around your health? *
I offer flexible payment options to work with me, if we're a good fit to work together, will you be ready to make a deposit to get started? *
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