First Name
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Last Name
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Preferred Name
Preferred Pro-nouns
Age
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What city/state do you live in?
Phone Number
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Email Address
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How did you hear about me? (Instagram, Tik Tok, etc.)
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What is your Instagram handle? For example, mine is @theguacwarddietitian (please double check that this is correct!)
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Preferred method of contact
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Bariatric surgery date and procedure (VSG, RNY, Duodenal Switch)
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Did you see a dietitian before or after surgery? If so, what has your experience been like?
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With as much detail as possible: what is the main reason you are reaching out to work with me? (Specify any nutrition related struggles)
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What type of support do you feel would be most beneficial towards reaching your goals? (group sessions, 1:1, etc.)
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My coaching programs start at $297 per month USD. If we feel this is the right fit, are you prepared to make this financial investment?
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My coaching programs are 4-12 months. Are you prepared to commit to this?
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Is there anyone else involved in the decision making process?
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Depending on your health insurance plan, it may cover a portion of my program. I am in network with BCBS, Aetna, UHC, Cigna and Mass General Brigham Health Plan. If you are interested in checking your insurance coverage, list your plan below.
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