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Apply to work with Alexa
First Name
Last Name
Email
Phone
How did you hear about me?
Google Search
Instagram or Facebook
Through Friends or Family
Other
What are your biggest challenges right now related to your health and wellness?
Which of the following apply to you?
My weight has yo-yo'd up and down as an adult.
I have tried one or more weight loss programs in the past.
I consider myself an emotional or stress eater.
I want to improve my health, but keep slipping into old habits easily.
I struggle with stress and burnout.
At times, I struggle to feel good about my body.
What are 3 goals you hope to achieve in the next 3-6 months? Be specific.
Have you worked with a Dietitian before?
Yes
No
Are you willing to commit to at-least 8 weeks of coaching?
When ideally would you like get started with working together?
Within the next 1-2 weeks
Within the next 3-4 weeks
Within the next 3 months
I am flexible
The Back to Balance Program starts at $997 CAD for 8 weeks. Are you ready to make that financial commitment at this time?
Yes
No
At this time, I only work with clients in Ontario, Canada. Do you reside in Ontario?
Yes
Which coaching format would you prefer?
One on one, with Alexa
Group Coaching (4-6 participants)
Is there any other information that you feel is important for me to know?
Please check this box, if you give permission to contact you using the information provided.
You will be contacted
within 3 business days
about the program.
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