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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?
*
A
Yes
B
No
C
Other: Please explain below
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
Yes
B
No
C
Would you be ok with the session being recorded, as required?
*
A
Yes
B
No
Additional Comments or Questions:
Submit