Application to get started
Hi šŸ‘‹ Congratulations on taking the next step in your health and growth journey! The fact that you are doing this means you are ready for real shifts and progress. I've got you, so let's get started.

Please fill out the form to the best of your ability, it will be reviewed and I'll be in touch to schedule a time to connect.

Until then,

šŸ‘©šŸ»ā€āš•ļø Dietitian Sandy
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Email *
What is you first and last name? *
Date of birth? *
Phone Number? *
Have you worked with a Dietitian/Nutritionist before? *
If so, who was it and for how long?
How did you hear about me? *
Referred by a Doctor or your insurance website?
If you found me through your insurance company or were referred by a doctor and planning to use insurance. NOTE I am not accepting insurance patients at the moment.
On a scale of 1-10, how satisfied are you with your health?* *
Least Satistied
Extremely Satisfied
What is the primary reason you are reaching out to work with me? *
What results would you like to achieve.? *
How important is that for you? *
Not Important
Very Important
How would feel, how would you & your life change if you were successful with your nutrition, health and weight goals after working together? *
What are your current frustrations and fears when it comes to weight loss, making behavior & lifestyle changes?
What has gotten in your way of achieving the results you want? *
How do you feel about that?
How much would you say you have spent on your health (including diet programs, trainers, supplements, surgeries, lab work, etc.) in the last 3-5 years?* *
On a scale from 1 to 10, what is your level of motivation for making a change? 1 - not motivated at all and 10 being 100% motivated * *
Not Motivated
VERY Motivated
At this time, are you willing to invest in yourself emotionally, timewise and financially with my nutrition and lifestyle coaching Programs?* *
Any additional info you'd like me to know prior to reviewing your application? *
Thank you for taking the time to complete this questionnaire. I'll review your application and a member of our team will contact you to scheduled a 15 minute phone STRATEGY Consultation. *
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Live + Life + Healthy
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