Coaching Application — Russ Powell Diabetes and Lifestyle Coach

We will work together to go beyond just taking medications to manage your diabetes or restrictive eating principles to lose weight. My signature program offers 3 levels. Each level of my program has some form of private coaching based off your specific accountability needs. Whether you are wanting to just get started or need hand-holding the entire time, I have you covered. Submit the application below and let’s start the conversation.

Name

First Name

Last Name

Social Media Handle

City and State

Phone

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I am most interested in help with...

One time consultation to better understand my diabetes risk

3-month Blood Sugar Restart Program

What concerns about your health and well-being brought you here? Be as honest and specific as you can.

In your own words: What is your number one goal you want to achieve during our time together?

If we are good fit, how soon are you looking to get started?

Are you comfortable in changing the way you view mental well-being and physical health? AKA they have to work hand in hand.

Yes

What barriers are in your way? Family, work, friends, social life, etc.?

Is there anyone else involved in the decision making process that needs to be on the call?

Are you okay with participating in a self-pay/private pay nutrition counseling/coaching program? If you would like to use your insurance, I can provide you with a Superbill (receipt with insurance codes) so that you can receive reimbursement directly from the insurance company. My services would be considered an out-of-network provider. Several of my clients receive 100% or a majority of their out of pocket cost from insurance. If you are unsure please contact your insurance provider to see if our services would be reimbursed.

Yes

Pricing Transparency: My program pricing reflects the level of accountability and support you require. Here's a breakdown: Enhanced Support (High Touch): $470/month - Ideal for those seeking intensive guidance and frequent check-ins. Moderate Support: $350-$400/month - Provides a good balance of personalized support and flexibility. Standard Support: $225-$300/month - Offers a solid foundation for managing your diabetes with regular check-ins. Payment Flexibility: We believe everyone deserves access to quality diabetes management. Flexible payment plans are available to help you fit this program into your budget. Ready to Invest in Your Health? If you're serious about lowering your A1c, achieving a healthy weight, and potentially reducing dependence on medications, let's chat! This program can be your key to a healthier and happier you.

Yes