Application for HEALTH REBUILD 365 program
If you're ready to. . .

* learn which foods are best to eat
* learn which foods are best to avoid
* end food fear, stress, anxiety and guilt
* stop second-guessing every bite you take
* stop thinking that what you're eating is "wrong"
* eat foods you enjoy without fear they'll trigger recurrence

This program is for you! Watch the 4-minute video below, then fill out the application to apply.
Sign in to Google to save your progress. Learn more
Click the video to learn how HEALTH REBUILD 365 will help you stop fearing food and eat with peace.
Date of Application *
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First & Last Name *
Best EMAIL to reach you at? *
If you have an Instagram account, please share your handle below. *
Phone Number *
How did you hear of the HEALTH REBUILD program? *
When did you finish treatment? *
Have you previously worked with a dietitian for your survivorship health concerns? If yes, what was that experience like? *
What prompted you to reach out to me for help? *
Why do you want to join my HEALTH REBUILD program? *
What are your biggest nutrition, exercise and lifestyle concerns and challenges? *
Describe for me what it's like living daily with the concerns and challenges you listed above. *
Why is it important for you to resolve these concerns and challenges NOW? *
What's holding you back from resolving these concerns and challenges? *
How are you hoping my HEALTH REBUILD program can help you if we work together? *
I'm taking serious applicants only who are ready to start in the next 30 days. How soon are you looking to get started? *
On a scale of 1-10, how committed are you to accessing the program materials, learning new information and prioritizing your survivorship health goals? *
Not committed at this time
100% committed, let's go!
At this time, what amount are you willing to invest to resolve the problems and challenges you described above? *
What are your reservations about making any level of financial investment in your health at this time? Please list them below. *
Who else is involved in the decision making process re: you working with me that needs to be on the call? *
If I’m able to give you a clear roadmap for how I can help you during our phone chat, then are you willing to give me a yes or no about working together at the end of our call? *
How would you prefer to communicate for next steps? *
By submitting this application, you'll be subscribed to my newsletter. *
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