Application to work with Tanya - The Lupus Dietitian
Ready to feel your best? Thrive with Lupus? You're in the right place! Tell me a little bit about yourself :) 
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Email *
First Name *
Last Name *
What state do you live in? *
What is your social media name on Instagram - I'd love to connect if we haven't already :) 
(i.e. @TheLupusDietitian)
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How did you hear about me? (Instagram, Facebook, TikTok, YouTube, Webinar, Lupus organization, doctor, friend, etc.) *
What have you been diagnosed with?  *
What best describes your current health concerns? (ex: fatigue, pain, rashes, pregnancy, stomach or digestion issues, organ damage, etc.)

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Are you ready and willing to invest in yourself and your health?

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On a scale of 1-10 how committed are you to doing what it takes to improve your health and achieve your goals in the near future?
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Not at all committed
100% committed, I want to start asap!
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