Work with Kim | The Somatic Dietitia

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Work with Kim
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First name

Last name

Email

Phone

Where is the best way to chat?

Instagram

Facebook

Text Message

If you pick Instragram/Facebook, what is your handle name on social media?

What are your current eating habits? Do you skip meals? Do you binge at night? What do you commonly eat? Do you make any food offlimit?

Have you done any diets? If so, what ones?

What is your biggest struggle?

Why do you want to change it now?

How committed are you to change this 1-10?

How much do you sleep at night? Do you wake up in the middle of the night?

How did you find me/who referred you?

If applicable, does your partner know you are seeking help from a dietitian?

Kim will reach out soon!

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