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Apply Today to Work with Christin Bummer

Fast Like a Girl Certified Coach

First Name *

Last Name *

Email *

Phone *

Time Zone *

What do you hope to accomplish with a fasting lifestyle (e.g. weight loss, improved health, mental clarity)?

What will keep you motivated and moving forward when you face challenges? Why is this important to you?

Have you been working on building a fasting lifestyle? What have you tried in the past? How is it going for you? It's ok if you're brand new too!

What is your current dietary strategy? How is it going for you?

What has gotten in the way of achieving your goals so far?

Do you have any concerns or fears about fasting? About this program?

As we will be discussing hormone balancing, please check the box that is most appropriate for you *

Regular Menstrual Cycles

Unknown, lacking, or irregular cycles due to medication, IUD, surgery

Perimenopausal (changes in menstrual cycle but not fully menopausal)

Postmenopausal (starting at what age?)

Please explain or add detail as necessary

Are you experiencing any menopausal symptons (e.g. hot flashes, night sweats, mood changes)? Please specify

On a scale of 1-10, how committed are you to trying new strategies to reach your goals? *

Are you willing to log your progress and share updates with me as your coach? Is there any reason you wouldn't?

The following are bonuses included with your program. Is there anything below that YOU ALREADY HAVE and DO NOT NEED?

Glucose meter

Ketone meter

Menopause Reset by Dr. Mindy Pelz

Fast Like a Girl by Dr. Mindy Pelz

Is there anything else you would like me to know about your health or lifestyle that might impact your participation in an Intermittent Fasting coaching program?

Next steps

I have read the Next Steps section below and understand there are no refunds once enrolled in this program.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Next Steps...

After you fill out the application, I'll reach out within 24-48 hours.
We can hop on the phone for a quick consultation (at no charge)
Once I better understand your needs, desires, and current status, I'll be able to better predict how long we'll want to work together and the investment you can expect.
If it's the right fit for both of us, you'll be invited to register and begin the onboarding process!
I'll ask you to fill out the initial intake forms, and with that detailed information I'll create a Personalized Care Plan just for you.
We'll hop on a Zoom call to go over your Personalized Care Plan and get you started!

FOR SUPPORT ISSUES OR QUESTIONS, PLEASE EMAIL ME AT [email protected]