I'm so glad you're here! I'd love to learn more about you, your goals and why you are interested in BBN Academy. Please read each question carefully and complete the application below with as much detail as possible! With my current Summer Promo you will get 1 additional month of coaching FREE! Promo pricing starts at $274.15 per month and is a minimum of 6 months commitment. Please only complete the application if you are able to commit to this.

First Name

Last Name

Preferred Name

Gender

Preferred Pro-nouns

Age

What city/state do you live in?

Phone Number

(###)

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####

Email Address

How did you hear about me? (Instagram, Tik Tok, etc.)

What is your Instagram handle? For example, mine is @theguacwarddietitian (please double check that this is correct!)

Preferred method of contact

(This is how I will be reaching out to you to discuss next steps!)

Instagram Message

Text Message

Bariatric surgery procedure and date you had it (IE - RNY 6/1/2025)

Did you see a dietitian before or after surgery? If so, what has your experience been like?

With as much detail as possible: what is the main reason you are reaching out to work with me? (Specify any nutrition related struggles)

Group coaching programs start at $274.15 per month USD with my current Summer promo. If we feel this is the right fit, are you prepared to make this financial investment?

My coaching programs are 6-12 months. Are you prepared to commit to this?

Yes

Is there anyone else involved in the decision making process?

By checking this box you're acknowledging being added to Haley's email list for special announcements and free resources. You can unsubscribe at any time.

Yes