Let's Talk!
Congratulations! You've just taken the first step on your health and wellness journey!

Hi I'm Jen Laurence! I am a Registered Dietitian and the owner and founder of Right Balance Nutrition. Let's take some time to get to know one another.

Watch the video and complete this form if you are interested in learning more about my 12 week weight loss and nutrition program Steps To Success. I'll reach out to you to talk further.

Thank you, and I look forward to speaking with you!
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Email *
Steps To Success Weight Loss Program 
First Name *
Last Name *
Phone *
Social Media Handle or Name *
What prompted you to reach out to me for help?
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What are you struggling most with in terms of your nutrition and why you are seeking support? *
Are you currently using any food tracking apps?
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If not, are you open to using one?
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Do you do well with high accountability?
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On a scale of 1-10 (10 being most important), how committed are you to making changes to your nutrition? * *
Are you looking for an overly structured/strict meal plan, or does something a bit more flexible sound appealing to you?
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At this time, are you willing to make a premium investment in your nutrition goals and a coaching program?
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Do you have any reservations about joining a nutrition coaching program? If so, please list them here! *
Is there anyone else involved in the decision-making process that needs to be involved on our call?
If we decide we are a good fit to work together during our phone chat, will you be ready to start in the next 30-60 days?
 *
What is your preferred method of contact?  *
What state or country are you located in? *
A copy of your responses will be emailed to the address you provided.
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