Strategy Nutrition Coaching Session Application
Are you ready to learn how to nourish your body and mind while actually enjoying food? Are you motivated to improve your health and well-being without food and body stress, preoccupation, guilt, and shame? Do you feel ready to ditch dieting once and for all? If so, apply for a  15-minute meet & greet with me!

I'd love to help you finally:

  • Break the yo-yo dieting cycle once and for all

  • Feel confident and comfortable in your body

  • Honor your body’s hunger and fullness signals

  • Gain more pleasure and satisfaction from your eating experiences

  • Remove the guilt, shame, and self-judgment from eating the foods you love

  • Learn other tools aside from food to have in your toolbox to cope with emotions

  • Honor your health by utilizing evidence-based nutrition information in a way that does not sacrifice your mental health and well-being

  • Reconnect to the joy of moving your body

Please take a few moments to fill out the questionnaire below. If I feel that we would be a good fit to work together I will contact you once I thoroughly review your application to schedule our initial complementary call. If after reviewing your application I feel that another healthcare provider would be a better fit to support you, I will offer you a referral(s). Thank you for your interest in working with me!

If you have any issues filling out this application form, please do not hesitate to reach out at crystal@renourishingroots.com.
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Name (first and last) *
Email address *
Phone number *
Date of birth *
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Where do you currently live?

*Please note that I am currently licensed in the states of Maine, North Carolina, and New York. I provide Medical Nutrition Therapy (MNT) one-on-one services for clients residing in these states. If you do not live in an area where I am licensed I will check with your states licensure laws prior to scheduling our initial call. I can provide individual nutrition coaching services for clients outside of ME, NC, and NY. Please note that this only applies for individual counseling sessions, and excludes groups offered by my practice.
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What are your main concerns, challenges, and/or struggles when it comes to eating, and how have these challenges impacted your relationship with food and life? (Choose your top 3)
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What have you done to try to work on these challenges? What was the outcome?
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If you no longer struggled with the above challenges, how would your life change? What would be different? (For instance, being able to be more present at holidays with family without stressing about the food, freeing up precious time in your day that you spend worrying about food and/or the number on the scale to focus on what's important to you, saving money by ditching expensive diet plans, having less digestive distress, better energy, etc.) *
What are your goals? What do you hope to achieve by working together?
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On a scale of 1-10 with 1 being not at all important and 10 being extremely important, how important is it for you to achieve your goals?
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Not important
Extremely important
Are you willing to invest in yourself in order to get the necessary support to achieve your health goals?
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I offer both individual and group virtual nutrition counseling sessions. For individual sessions, my rates are $180.00 for an initial session (60-75 minutes), and $125.00 for follow-up  sessions (50 minutes). My 12-week intuitive eating group program is $360.00, or $30.00 per group class. How comfortable are you in making this kind of investment in yourself at this time?

*Please note that prices for Anticancer Lifestyle Program participants may differ.
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At this time I do not take health insurance. *
Required
My practice is 100% virtual. I do not provide in person sessions. *
How would you like to work together? *
Do you agree to be added to my mailing list by submitting this form? You can unsubscribe at any time.
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How did you hear about me? Please specify below.
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