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Name
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First
Last
Email Address
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Phone Number
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Instagram handle (i.e. @the.mindful.nutritioinst)
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How did you find me?
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Instagram
Facebook
Tik Tok
Google
Personal Referral
Other (if other please add below)
where to find
How do your prefer to communicate for next steps?
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IG DM
FB Messenger
What prompted you to reach out to me for help?
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What are your biggest challenges or obstacles with your nutrition and reaching your health goals?
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What are your main 2-3 health goals you would love to finally achieve while working with me?
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What's stopping you from achieving those goals?
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What have you done in the past in an attempt to solve these challenges? What did and didn't work? Examples: Weight Watchers, counting calories, paleo/keto or other diets, etc.
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On a scale of 1-10, how committed are you to making changes with your nutrition and reaching your health goals?
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0
My nutrition approach is to create mindful, balanced, and sustainable changes that work for your individualized lifestyle. Are you open to learning how to achieve healthy weight loss WITHOUT counting calories, macros, etc with a flexible approach?
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Yes!
No I want a structured/strict meal plan
Willing but nervous
My proven framework has helped hundreds of women lose weight and keep it off. If we decide together that this is the right fit for you, I’m confident my program will be the last thing you need. You'll get personalized coaching & acquire the tools you need to sustainably lose weight and never diet again. I offer flexible payment options (including accepting HSA/FSA). Please check all that you would be comfortable investing MONTHLY in your health below.
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$250-$400/month
$450-$600/month
$650-$800+/month
I’m willing to talk this out because I want to make this work for me!
Is there anyone else involved in the decision-making process that needs to be involved on our call?
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Do you have any reservations about moving forward and joining a nutrition coaching program? If so, please list them here.
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If we decide we are a good fit to work together during our chat, will you be ready to start in the next 30-60 days?
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Yes, I can't wait!
No, I need more time
Maybe
Is there anything else I should know?
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