Sprout Application 
I help women and mom's help themselves and help their families with more healthy habits, mindful eating and healthy approaches. Please fill this out for you and your family.  
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Full Name *
Email Address *
Phone Number *
Social Media Handle or Name
What is your biggest struggle with food and your body? *
What are your family goals, if any? 
If applicable, does your child have any special needs or picky eating?
What is the main goal you hope to achieve from this program? *
Do you currently have a diagnosed active eating disorder?
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I currently do not work with minors. Are you 18 years or older?
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Do you have a therapist?
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Are you ready to invest in yourself emotionally, financially and physically? *
Do you have any reservations about joining a nutrition coaching program? If so, please list them here! *
Is there anyone else involved in the decision-making process that needs to be involved on our call? *
If we decide we are a good fit to work together during our phone chat, will you be ready to start in the next 30-60 days? *
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