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Clarity Coaching Session Application

First and Last Name

Email Address:

Phone Number (optional)

What interests you about the ketogenic diet for mental health?

Do you have any prior experience with the ketogenic diet?

Do you have any prior experience with the ketogenic diet?
A
B
C

What are some specific goals you hope to achieve?

If approved, can you afford to pay a discounted rate of $30.00 for a 60-75 minute session?

Untitled multiple choice field
A
B
C

Would you be ok with the session being recorded, as required?

Would you be ok with the session being recorded, as required?
A
B

Additional Comments or Questions: