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Join the Waitlist for Transformative Small Group Coaching Program!

First and Last Name

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Email Address:

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Phone Number (optional)

What interests you about the ketogenic diet for mental health?

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Do you have any prior experience with the ketogenic diet?

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Do you have any prior experience with the ketogenic diet?

A

Yes

B

No

C

Other: Please explain below

What are some specific goals you hope to achieve through this program?

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How did you hear about this program?

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Additional Comments or Questions: