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Name
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Name
First
First
Last
Last
Phone
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Are you on social media? If yes, which platform and what is your handle (how are you listed)?
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What prompted you to reach out to me for help?
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What are your biggest obstacles or challenges with your nutrition?
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Do you do well with high accountability?
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Yes
No
On a scale of 1-10, how committed are you to your personal nutrition goals?
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5
1 is least committed, 10 is most committed.
Are you looking for an overly structured/very structured meal plan or does something a little bit more flexible sound appealing to you?
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Structured
Flexible
Are you ready to invest in your health now or within the next 2 months?
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Yes, I am
Not at this time
Is there anyone else involved in the decision making process who should be on a call with us?
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If I am able to give you an exact roadmap to success during our phone call, are you willing to schedule to start at the end of our discovery call?
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Yes
Possibly
No
If you are human, leave this field blank.
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