Nutritional Coaching
If you'd like to receive nutritional coaching with Kacie, please fill out this form.  Thank you!
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Email *
Name
Phone Number
Preferred email address
May I send you text messages and emails? *
What are your top 3 health goals?
Have you ever tried a specific diet or eating plan?  If so, please elaborate.
Are you currently working with a doctor, nutritionist, dietician, or alternative therapy provider? If so, please explain what work you've done with them.
Are you currently on and vitamins or supplements?  If so, please list them below.
How often do you exercise?
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I meet with clients weekly, biweekly, or monthly.  What do you prefer?
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I meet with clients over Zoom Video Conferencing.  Do you agree to this method of communication? *
I am happy to reschedule with 24 hours or more advanced notice.  Sessions cancelled with less than 24 hours' notice will be charged in full.  Do you agree? *
I use Stripe payment processing to auto draft your payment based on your personalized plan.  Do you agree to this payment method? *
I AM NOT A MEDICAL PROFESSIONAL AND CANNOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, text, graphics, images and other material contained in our coaching sessions are for informational purposes only. No material or suggestions shared in our sessions are intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of information acquired in our coaching sessions.

By typing your first and last name below, you consent and agree to the terms above.
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A copy of your responses will be emailed to the address you provided.
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