Application - Therese Martinez, RD

Name *

First

Last

Email *

Phone Number (include country code if outside the U.S.) *

How did you discover me?

Which program are you interested in? *

Why are you interested in working with me? *

What are your main goals? What do you want to improve, feel like, or be able to do? *

What are your obstacles and challenges? *

Are you willing to fill out a check-in form every week?

Are you committed to showing up for your one-on-one sessions?

(For group programs only) Are you committed to participating in group calls and activities?

On a scale of 1 (not at all committed) to 10 (all in!), how committed are you to putting in the time to prioritize your health goals?

Selected Value: 0

Are you prepared to make this investment in yourself?

Will you be able to make a definitive decision?

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