Application for The Health Jumpstart Session
We are so excited you are here! The Health Jumpstart Session is a 1:1 strategy call with us where you will walk away with a clear strategy to achieve your health goals. This is an application to ensure we are the best fit to help you reach your health & wellness goals.

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Full Name
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Email Address

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Phone Number
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Date of Birth
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Location (City & State or Country)
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Please list your health concerns in order of priority.

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How are these health issues impacting your day-to-day living? (i.e. Is this situation preventing your from doing things that enjoy? Impacting your ability to focus, your social life or relationships, your career, etc.?)
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What have you tried in the past to improve your “health situation” and and what were the results?

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What other specific help have you sought in the past to help you achieve your health goals? Have you worked with a dietitian or coach before?

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What are your health goals and how would achieving them improve your quality of life?

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What are the areas in which you feel you need the most help, direction, and support to help you move forward? In other words where do you feel most stuck?

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What treatments, protocols, cures, and approaches have you tried?

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Did any of these treatments, protocols, cures, etc help you? If they didn't can you tell us why? *
Making significant and sustainable health changes can literally save your life (and certainly transform your quality of life!) And... 
It often requires time, resources and personalized support to create lasting change that supports your health goals. Are you willing to invest in yourself to get the support you need to move forward?
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On a scale of 1-10 how committed are you to doing what it takes to improve your health and achieve your goals in the near future?

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Not Important At All
Extremely Important

Is there anything else you'd like us to know?

Thank you for completing the application!
We will review all of your information & get back to you. If we feel this is a great fit, we will also send over a link to book your jumpstart session! Be sure to add lyssie@nutritiontwins.com and tammy@nutritiontwins.com so our emails don't end up in your spam/junk folder!
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