Take Action » Jennie Dore Nutrition and Wellness

What made you take the step to apply for nutrition coaching? *

What are currently your biggest challenges limiting you from meeting your health goals? *

How long have you been struggling with this?

health challenges, sustainable weight loss, making the positive changes for yourself

Do you have any current medical conditions? *

How committed are you to change your current lifestyle and habits? *

0 = Not Committed 10 = Extremely Committed

Why did you rate yourself this way?

what is limiting you from feeling more committed?

What will happen in 6-12 months if you do not take action now? *

Are you willing to take 15 min per day to log your daily food / lifestyle? *

What do you expect of me as your nutrition coach? *

The value of my coaching program requires a financial investment in yourself. You are able to use Health Savings or Flexible Spending Accounts, but I do not work directly with insurance companies. Are you willing to invest in yourself to achieve lasting health? *

It is important to me that all decision makers are present during your discovery call. I want to honor the fact that this person is part of your journey to live a healthier and happier life. Is there anyone else in the decision making process who will need to be present during our discovery call? If so, who? *

Your Name *(Required)

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Your Personal Email *

Your Cell Phone *

How did you hear about working with me? *

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