Part 1

A little about you

First name *

Please add your first name.

Last name *

Please add your last name.

Email *

Please add a valid email.

Phone *

Please add your phone number.

Yes, Dana Cushing Health may text me about my application and call. Message and data rates may apply. Reply STOP to opt out. (Optional)

Age range *

Please choose one.

Instagram handle

Part 2

What's happening right now

What is happening with your weight, sugar cravings, or health right now that made you reach out? *Your real life, not the perfect version. A few sentences is perfect.

Please share a little here.

Which of these sound like you? *Choose all that fit

I eat healthy and exercise, but I still can't lose weight.

I do well all day, and then the pantry happens.

My sugar cravings get loud, especially later in the day.

I start over a lot. “I'll get back on track tomorrow.”

I want to eat carbs without gaining everything back.

I'm busy taking care of everyone and don't put myself first.

Please choose at least one.

Part 3

What you've already tried

Which have you tried? *None of this counts against you. It helps me see the pattern.

Please choose at least one.

What happened, and what made it hard to keep going? *

Please share a little here.

Part 4

Where you want to go

If we were talking six months from now and you were thrilled with your progress, what would be different? *Think about your body, your energy, your cravings, and how you feel around food.

Please share a little here.

Part 5

What you're looking for

What are you looking for from a coach that you haven't been able to get on your own or from other programs? *Maybe it's accountability, a plan that fits your real life, help with cravings, learning to eat carbs with confidence, or something else entirely.

Please share a little here.

Is there anything about your health you'd like me to know before we talk?Optional. Brief is fine. Full health history comes later.

Please share a little here.

Part 6

How you found me

Where did you find me?

Was there a post, email, resource, or person that made you decide to apply?I'd love to know what made you think, “Okay, she's the one I want to talk to.”

Please share a little here.

Part 7

Your investment

Diet Different™ Private Coaching

A low four-figure investment

Through personalized, RN-led coaching, we identify the patterns keeping the scale stuck, decide what matters most, and adjust your nutrition, routines, and support as you progress. You learn how to lose weight, calm cravings, and keep moving forward with carbs and your favorite foods still included. Payment plans are available.

If we decide private coaching is the right fit, which best describes where you are right now? *

I'm comfortable making a low four-figure investment in my health if it's the right fit.

A payment plan would make the most sense for me, and I'm comfortable with the overall investment.

This is out of my budget right now.

Please choose one.

I understand this is health, nutrition, and weight-loss coaching. It does not replace my physician or provide medical diagnosis or treatment.

Please check this box to continue.

Apply for Private Nutrition & Weight Loss Coaching

A little about you

What's happening right now

What you've already tried

Where you want to go

What you're looking for

How you found me

Your investment

Thank you for trusting me with this.