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Green Sage Mentorship Application

Fill out this brief application to request a call with me and get started on your fully customized plant-based journey.

I'm excited to get to know you better!

Once you submit the application, I'll contact you to set up an appointment. On our call, I'll be able to answer your questions and we can determine together if Mentorship is the right fit for you. 

Click the button below to start.

Start

Question 1 of 15

Which of the following describe(s) your current diet or eating habits?

(Select all that apply)
A

vegetarian

B

vegan

C

omnivore

D

flexitarian

E

pescatarian

F

consistently healthy

G

mostly organic

H

frequent junk food

I

occasional junk food

J

frequent processed food

K

occasional processed food

L

frequently dine out

M

occasionally dine out

N

always cook at home

O

frequently snack between meals

P

occasionally snack between meals

Question 2 of 15

What do you usually eat and drink? Please list what you would consume in a typical day for breakfast, lunch, dinner, snacks and beverages.

Question 3 of 15

Is there anything in particular you'd like to change about your current eating habits?

(Select all that apply)
A

go completely vegan

B

eat more plant-based meals

C

cook more healthy meals at home

D

eat healthier snacks

E

plan my meals for the week in advance

F

learn to cook with new ingredients

G

cook more varied meals

H

eat healthier to lose weight

I

eat fewer processed foods

J

drink less coffee

K

drink less alcohol

Question 4 of 15

Are you currently exercising? If so, what kind of exercise do you do, and how frequently?

Question 5 of 15

Do you meditate regularly? If so, how often? If not, would you like to learn?

Question 6 of 15

When it comes to a plant-based diet, what are your main concerns?

(Select all that apply)
A

Not sure I can get all the nutrients I need without animal products

B

Don't know what or how to cook without meat, dairy or eggs

C

Afraid I'll gain weight if I eat too many carbs

D

Concerned I'll miss some of my favorite foods or feel deprived

E

Nervous I'll have trouble fitting into regular social situations

F

Doubtful I'll still feel full if I don't eat meat

G

My spouse or child(ren) are not on board with a plant-based diet

H

Other

Question 7 of 15

What are you most excited about with regard to a plant-based diet?

(Select all that apply)
A

Feeling good about what I'm eating and/or feeding my loved ones

B

Reducing risk of illness

C

Not harming animals

D

Helping to protect the environment

E

Gaining energy

F

Never having to diet again

G

Gaining knowledge/confidence about what to buy at the grocery store

H

Gaining confidence/skill in the kitchen

I

Knowing exactly what to eat/cook

J

Having a more varied diet, enjoying new meals

K

Losing weight

L

Reversing disease (heart disease, high blood pressure, high cholesterol, type 2 diabetes)

M

Other

Question 8 of 15

What do you anticipate you'll need the most help with?

(Select all that apply)
A

Cooking! I'm a total beginner in the kitchen.

B

Grocery shopping! I don’t know much about different healthy foods, or where to buy them.

C

Sticking to it! I’m afraid I’ll cave and eat cheese or ice cream, or grab a donut when I’m hungry.

D

Nutrition! How will I know if I’m getting everything I need?

E

Motivation and accountability! I tend to be excited at first, but it’s hard to change old habits.

F

Other

Question 9 of 15

Do you have any food allergies or dietary restrictions of any kind?

If so, please describe. (e.g. nut allergy, gluten sensitivity, kosher, halal, etc.)

Question 10 of 15

Do you have any weight loss goals? If so, please specify.

Question 11 of 15

At home, you are cooking for:

(Select all that apply)
A

Yourself

B

Your partner

C

Your roommate(s)

D

Your child(ren)

E

An elderly relative

F

Other

Question 12 of 15

Do any of the following describe you?

(Select all that apply)
A

Health conscious

B

Open-minded

C

Self-disciplined

D

Animal lover

E

Environmentalist

F

Enjoy learning new things

G

Interested in personal development

H

Spiritual

I

Science-minded

J

Naturally skeptical

K

People person, enjoy group activities

L

Prefer solitary activities, alone time

Question 13 of 15

Is there anything else in particular you'd like me to know about you? Please fill me in below.

Question 14 of 15

What's the best way to reach you to schedule a phone or Zoom call?

A

Phone call

B

Email

C

Text message

D

Social media messenger (Facebook, Instagram, What's App, Voxer, Marco Polo, etc.)

Question 15 of 15

Please write your contact details below for your preferred method of contact (phone number, email address, preferred social media platform and handle, etc.)

Confirm and Submit