Application Form

I only work with adults with CKD. Can you please confirm that this application is not for a child with CKD?

Yes, I confirm.

When were you diagnosed with CKD?

Recently diagnosed

1-3 months ago

4-6 months ago

6+ months ago

What stage of CKD do you have?

CKD stages 1-2

CKD stages 3a or 3b

CKD stages 4-5

I don't know

What have you tried in the past for your CKD?

Drinking more water

Eating less sodium

Following the one page handout my doctor gave me

Nothing - I don't know where to start

Have you tried a plant based diet for your CKD?

Yes, but it's not for me

Yes, but it's bland and boring

No, I haven't tried that yet

On a scale of 1 to 5, how committed are you to your personal nutrition goals?

1 (Not motivated at all)

5 (Extremely motivated - will do what it takes!)

In this program, you’ll get hands-on private coaching to help manage & improve your kidney health in a realistic and sustainable way. My private coaching program costs $2997.00 for a 3 month program (I offer flexible payment plans: $499/month for 6 months OR $999/month for 3 months or offer a $200 discount if you make a one time payment of $2797). I also accept HSA/FSA payments so that this program can work for you in every aspect! If we both decide that we're a good fit to work together, are you in a place to make this personal and financial investment to manage your CKD?

Yes

Yes - with a payment plan

If I’m able to give you an exact roadmap to success and we both agree that you're a good fit for the program, are you ready to start the program?

Yes

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