Application Form

Want to get your insurance benefits checked?
To learn more about the process and get your benefits checked, click here!

Name

First Name

Last Name

Phone

(###)

###

####

IG Handle

How did you hear about us?! Did someone refer you?

Do you have an active eating disorder or are in treatment for an eating disorder?

Program Options:

Which Coaching Program(s) are you Interested in?

1:1 Coaching

Pick My Brain Session

Group Coaching

All

Use of Insurance Benefits

What brought you here today? Why are you taking this step to change your eating habits?

In your words, what is your number one goal you want to achieve by joining the HSH family?

Try to dig deep and give us some detail here.

Are you willing to make changes to not only your eating habits but also lifestyle changes to reach this goal?

Are you OK and comfortable with weight neutral, behavioral based nutrition coaching?

AKA not following a FAD diet, counting macros or deleting entire food groups?!

What is preventing you right now from getting to your change?

Are you willing to commit to a premium coaching investment in YOURSELF to learn how to eat right for the rest of your life - and free yourself from restriction & deprivation?

Please Note: Package pricing for 1:1 coaching is $649/month

INSURANCE POTENTIAL:

Please note our practice now participates with many insurance companies - state specific. Depending on your benefits we may be able to decrease the cost of your monthly investment for working with our team! If you are interested in having your benefits verified please click here to submit your insurance information so we can verify your benefits: https://www.happystronghealthyrd.com/insurance