Nutrition Coaching Application

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Thank you for being interested in investing in your health with nutrition coaching with me! Please fill out this application.

Once you complete this form, I'll reach out to you with a link on where you can schedule a consultation call.

PLEASE READ:
My practice is focused on working with mono and multiracial women of color.

I do not work with clients focused on fat loss as their primary or sole health and wellness goal. In our work together, your body composition could change, depending on other changes or small steps that are taken, but that is not the focus of my practice.

**Please be aware: I can not treat or diagnose any health or medical condition. If you are looking for a specific diagnosis or treatment plan, please consult a different medical or nutrition professional. I also cannot provide disordered eating or eating disorder support. **

Full Name *

Pronouns *

Email Address *

Time Zone *

Pacific Time

Mountain Time

Central Time

Eastern Time

Occupation *

Age *

Your Ethnic Background (select all you identify with) *

Indigenous

Black or African American

Asian

Native Hawaiian or Pacific Islander

Latin or Spanish

Multiracial

Other:

Required

What would you like to focus on by working with a nutritionist? *

What would you like your life to look and feel like, as far as your health and wellness? *

What is not working in your life right now related to your health and wellness? *

What does health and wellness look like to you? *

What is something health-related that confuses you or frustrates you? *

On a scale from 1-10, how ready do you feel to invest in your health and wellness? *

Not Ready

SO READY

Any additional information you would like to share with me about your cultures or background?

Any additional information you would like to share with me?

How did you find me? *

Google Search

Small Steps Podcast

Small Eats blog reader

NTA Website

Other:

I confirm that I've read the introduction of the form and am aware that Aimee doesn't focus on fat/weight loss health goals, can't treat or diagnose and doesn't offer ED support. *

Confirmed

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