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Pre-Call Form

PLEASE FILL OUT THE FOLLOWING APPLICATION WITH AS MUCH INFORMATION AS POSSIBLE to help maximize our time on this 30-45 minute call. If you haven't already selected a time slot, I will reach out to you and set one up to confirm you are a good fit to work with my team and I.

Click the button below to start.

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Question 1 of 14

1.) What are your 3 main nutrition, exercise, and diabetes goals?

Question 2 of 14

2.) Tell me about the obstacles preventing you from achieving these goals.

Question 3 of 14

3.) Tell me about your exercise history, including any injuries that would limit your ability to exercise.

Question 4 of 14

4.) Tell me about your diabetes situation. Are you on a pump or injections? Do you have a CGM? What is your most recent A1c? Are you on other medications for your blood sugar?

Question 5 of 14

5.) Are you open to tracking your nutrition?

A

Yes!

B

No.

Question 6 of 14

 6.) Why do you want to work with me?

Question 7 of 14

7.) Most people who commit to changing their lives on this program feel very comfortable investing $300+ monthly (which may be even less through approved insurance plans). Check yes if you are just like them and ready to invest in your best life starting today.

A

Yes!

B

No

Question 8 of 14

8.) Nutrition coaching is both a financial and time commitment. Is there anyone else involved in the financial decision-making process? If so, who is it, and would they like to be involved in the call?

Question 9 of 14

9.) In an absolutely perfect world, if we find this is a good fit, when would you like to start the program?

A

As soon as possible

B

Within this next month

C

More than a month from now

Question 10 of 14

10.) Are you willing to make a decision that will best benefit your health goals while on this call?

A

Yes, absolutely

B

No, I’m not ready to change yet

Question 11 of 14

11.) Please provide your name, phone number, Instagram username, and email.

Question 12 of 14

12.) What state are you from?

Question 13 of 14

13.)  What insurance provider do you have?

Question 14 of 14

14.) How did you hear about us?

A

Instagram (@manoftzeel)

B

Diabetes Strong

C

Google

D

Other

Confirm and Submit