Jumpstart Weight Loss Survey Jumpstart Weight Loss Survey To get started, please answer questions below Name Email Phone Number Age In a few sentences describe your reason for seeking help from a dietitian nutritionist? Describe what ideal success would mean as we work together Why are you not reaching your goals right now? If we decide we're a good fit, how soon can you get started? What statement BEST describes you: I am willing and able to invest time and resources to improving my health and making lasting changes in my life I am curious about improving my health but not sure if now is the right time or not I have absolutely no desire to change my diet or do anything other than what I am currently doing Some portions of the program are covered by insurance and some portions are out of pocket. Is this a problem for you? Yes, I am willing to invest in my health No, I am only interested in what insurance will cover Submit my survey!