Application

Please fill out this application to see if you’re a good fit for
The Nourished Divergent Path
6-month nutrition + wellness coaching program for women with ADHD.

Name

First Name

Last Name

Phone

(###)

###

####

What are your biggest challenges when it comes to managing your ADHD symptoms? (e.g., food, focus, emotional regulation, overwhelm, etc.)

How are you affected by food-related challenges like meal planning, overeating, under-eating, and/or emotional eating?

What is your main goal or hope for joining The Nourished Divergent Path?

This program is designed to support you as a whole person—not just manage symptoms. Have you worked with a holistic health practitioner before? What did you find helpful / unhelpful?

The investment for this program is $250/month. Is this within your capability right now?

Yes - I know I need support and am ready to prioritize my health

Maybe - I need more info about the program before I can decide

No - I cannot afford this and need a lower-cost option

What questions do you have for me?

How did you hear about this program?

Preferred Method(s) of Communication:

Text

Voice note (iPhone only)

Phone call

Zoom/video call