I am so thrilled to work with you! Please fill in the form below before our first session.


Personal Information
Name *
Phone *
Date of Birth
Date of Birth
As scales aren't the only way to measure weight loss, I'd like to leave this section up to you to decide. You can go off clothing, or by taking measurements of the body. Or if you like you can leave this section blank.
Health Information
(Please list your breakfast, lunch, dinner, snacks, and liquids)

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