The Fiber Mom Method - Application

Are you a mom?*YesNo

Describe your health and weight loss journey up until now.*

What have you tried so far to lose weight?* (Check all boxes that apply)Low CalorieCutting Out CarbsPersonal TrainerNutritionistDietitianShakes/Pills/Powders/BarsOther (Describe Below)

How long have you been struggling with your weight?*

What are your top 3 goals for the next 12 months?*

What’s standing in the way of you achieving your top 3 goals? (Please be honest and as specific as possible!)*

How do you believe the support of a dietitian can help you move toward greater success in your health goals (physical, mental, emotional)?*

What’s the most frustrating part about this for you?*

What’s one belief you need to let go of in order to take this next step towards working on your health and weight loss goals?*

What’s your biggest fear about taking the next step?*

How would your success in your health and weight loss goals positively impact every area of your life and your family's life? What would be different for you?*

Which statement best describes you?* I am WILLING and ABLE to invest time & resources into improving my health and making a lasting change in my lifeI am curious about improving my health but not sure if now is the right time or not

My program is a customizable weight loss and mindset plan for moms who want to level up, reach their weight loss and health goals, increase their confidence, and show up fully in life. How does that sound?* Amazing! Exactly what I needExcited but nervous. I know I need expert help but I'm nervous to get out of my comfort zone

What's your Instagram handle? (I'll be sending you a DM if your application is accepted)*

Is there anyone else involved in making financial decisions with you?*I handle my own moneyYes, my partner/spouse is involved

How did you find me?* InstagramFacebookGoogle or Internet SearchPodcast InterviewFriend or Family MemberOther (List Source Below)

I verify this information is true.*