Starting Coaching with Granny Keto

 

Granny Keto LLC, P.O. Box 3429, Framingham, MA 01705-3429
grannyketo@gmail.com

I'm looking forward to working with you as your nutritional coach. I know this may seem like a long form but the more information I have in advance of our first meeting, the more quickly we can get to work!

For scheduling purposes, please provide three choices for available dates and times. Leave the choices blank if you don't see a time that works and I'll do my best to work out a solution. For information about refunds and cancellations, as well as general information about coaching, see the Coaching FAQ page. If you prepaid for a group of people, please add their names, phone numbers, and email addresses below, so I may send them this form.

Name *
Name
Address *
Address
Best Phone # *
Best Phone #
Signature for Medical Disclosure Agreement *
Signature for Medical Disclosure Agreement
By completing the medical information section and providing my name below, I agree to disclose to Granny Keto, LLC, medical information, including but not limited to, pertinent medical diagnoses and medical test results in order to facilitate coaching sessions. Granny Keto will never share this information, or solicit medical information from medical providers.
Do you have any special circumstances that you would like to work on, such as preparing family meals, how to eat on the go, special dietary needs (allergies, sensitivities, religious dietary restrictions, etc.)
I understand the Terms and Conditions *
For information about cancellation and refund policies, see the Coaching FAQ page.
Friends & Family Group
First and last name, phone number, email address
First and last name, phone number, email address
First and last name, phone number, email address
Privacy Policy Acknowledgment *

For details about how your personal information is protected, see my Privacy Policy. By filling out this form and making payment, you've entered into a contract with Granny Keto LLC and agree that each coaching package will be paid in advance and is non-refundable.