First Name *

Last Name *

Phone *

By submitting my information, I consent to receive calls and text messages from Kayley George Registered Dietitian, LLC at the phone number and email address that will be provided. Our Privacy Policy and Terms & Conditions apply.

Email *

By providing your email, you consent to receive promotional emails from Kayley George Registered Dietitian, LLC.

When it comes to your body and health, what are 3 changes you'd like to make? *

On a scale from 1-5 how important is it for you to reach these goals? (1 is something you are just thinking about; 5 is something you WANT and NEED to do and are ready take action on NOW) *

What is holding you back from achieving those goals? *

Have you ever been diagnosed with any medical conditions? If yes, please list/explain

We offer a range of options in Ditch The Diet programs designed to fit different needs. Which of these best describes the level of support you are looking for? *

I’m looking for a program that’s fully covered by insurance* to receive personalized nutrition and lifestyle coaching to support my health and weight goals

I’m ready to make a SIGNIFICANT investment in a personalized, premium-level program that leaves no stone unturned—using advanced functional medicine testing, tailored nutrition strategy and meal plans, and expert 1:1 coaching to address the root causes of my weight and health challenges for lasting results.

*Please note that our insurance-based Jumpstart program requires a $79 on-boarding fee*

Do you have Blue Cross Blue Shield, Cigna, Aetna or United Insurance? We also accept HSA/FSA cards, Care Credit, and can provides receipts if we are out-of-network providers Select your primary insurance holder. Please note: Secondary insurance is not accepted. Medicare is NOT accepted.

What is your approximate height and weight? *

Please note that Aetna, United, and Cigna insurance may not provide any coverage if you do not have an overweight (BMI >25) or obese (BMI>30) diagnosis. A diagnosis must be documented with a medical provider.

How did you hear about Healthy Weight Loss Dietitians? *

If you selected other, referral from friend, or referral from practitioner, please provide more information:

Confirm that you are over the age of 18 and a resident of the US or Canada *

Confirm that you are over the age of 18 and a resident of the US or Canada