Application — haley lemieux

I'm so glad you're here! I'd love to learn more about you, your goals and why you are interested in BBN Academy. Please read each question carefully and complete the application below with as much detail as possible! Coaching starts at $257 per month and is a 4-6 month minimum program. Please only complete the application if you are able to commit to this.

First Name

Last Name

Preferred Name

Preferred Pro-nouns

Age

What city/state do you live in?

Phone Number

(###)

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####

Email Address

How did you hear about me? (Instagram, Tik Tok, etc.)

What is your Instagram handle? For example, mine is @theguacwarddietitian (please double check that this is correct!)

Preferred method of contact

Instagram Message

Bariatric surgery date and procedure (VSG, RNY, Duodenal Switch)

Did you see a dietitian before or after surgery? If so, what has your experience been like?

With as much detail as possible: what is the main reason you are reaching out to work with me? (Specify any nutrition related struggles)

What type of support do you feel would be most beneficial towards reaching your goals? (group sessions, 1:1, text support, etc.)

My programs start at $257 per month USD. If we feel this is the right fit, are you prepared to make this financial investment?

My coaching programs are a minimum of 4-6 months. Are you prepared to commit to this?

Yes

Is there anyone else involved in the decision making process?

By checking this box you're acknowledging being added to Haley's email list for special announcements and free resources. You can unsubscribe at any time.

Yes