We offer love working with diabetics who are serious about transforming their health and reversing insulin resistance.

To find out how we can help, and to assess whether you are a good fit for our coaching programs, click the start button below to complete a brief survey. It should take you about 5 minutes.
Start
 
What is your first name? *

 
What is your last name? *

 
What is your best email address? *

 
What is your best phone number? (Please provide a Skype username if you live outside the United Sates). *

 
How old are you? *

 
What is your current bodyweight (in pounds)? *

Metric system: Multiply your weight in kilograms by 2.2 to calculate your weight in pounds
 
What is your ideal bodyweight (in pounds)? *

Metric system: Multiply your weight in kilograms by 2.2 to calculate your weight in pounds
 
I am living with: *


 
In what year were you diagnosed?

 
What was your most recent HbA1c level (%)? *

 
Are you using oral medications to manage your blood glucose? If so, please provide the details. *

 
Are you using insulin to manage your blood glucose? *


 
What types of insulin do you use?

Insert brand name of insulin (Humalog, Novolog, Apidra, Lantus etc.)
 
What is your injection method?


 
Approximately how many units of rapid acting insulin do you inject at breakfast?


 
Lunch?


 
Dinner?


 
Snacks?


 
Correction Boluses?


 
What is your average fasting blood glucose? *

Metric system: (mmol) Imperial system: (mg/dL)
 
What do you eat for breakfast? *

 
What do you eat for lunch? *

 
What do you eat for dinner? *

 
Approximately how many grams of carbohydrates do you eat per day? *


 
Approximately how many grams of fat do you eat per day? *


 
What is your #1 most important fitness goal for managing diabetes? *

 
Approximately how many hours of total exercise do you perform per week? *


 
In regards to diabetes, what is your biggest frustration right now? *

 
What of the following services have you used in the past? *


 
What is your current occupation? *

 
What is your activity level in your job? *


 
Are you willing and able to invest a few thousand dollars in your diabetes health right now? *


 
Is there anyone else involved in the decision of joining a coaching program?


The next step is to schedule a time to speak on the phone to see if any of the Mastering Diabetes coaching programs are good fit. Please click the button below:
Book your session
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Thank you for filling out the form. You'll get an email soon with more information. In the meantime, checkout some testimonial videos on YouTube.
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