Getting to Know You

Thank you for your interest in personalized Diabetes Wellness Coaching with Lisa of diaVerge Diabetes! 

Before we get started, we'd like to learn about you:

  • How do you feel about your health right now?  
  • What would you like to improve in the future? 
  • In what areas are you feeling stuck? 
  • Are you interested in low carb and don't know where to start? 
  • Have you been eating low carb for a while but your results aren't what you were expecting? 

We're here to help you reach your health-related goals with proven coaching strategies and methods that will provide you with motivation, inspiration and support through the process. 

Please complete the following form to get started with online Diabetes Wellness Coaching. We'll reply within 24 hours with time/date options to schedule our initial Diabetes Wellness Coaching session. 


*Completing the following form is in no way binding. There is no obligation. You will receive one email from us to schedule a time for our initial Diabetes Wellness Coaching session, and one follow-up email in case you missed the first. There will be nothing more unless you choose to be added to our mailing list.

We take your contact information and all personal information included here very seriously and will not sell or trade it to anyone for any reason. All information included here will remain completely confidential

Thank you again for your interest in improved health. Take the first step today!


Please complete the form below to get started with personalized Diabetes Wellness coaching: 

Name *
Phone (to be used only in case of an email error) *
Phone (to be used only in case of an email error)
Do you have diabetes? Are you a caretaker for someone with diabetes? *
What is your (or your loved one's) diagnosis? *
How many times per day do you check your blood glucose levels? *
What medications & tools do you use to manage diabetes? Click all that apply. *
How Familiar Are You with Low Carb and/or Dr. Bernstein's Diabetes Solution Book? Click all that apply. *
What days and times are best to schedule a coaching session? Example, please use the format: Mondays from 2-5 PM Eastern & Wednesdays from 8-9 AM Eastern. (Note that each session will require a few additional minutes to schedule the next appointment time.)
How did you learn about diaVerge Diabetes? *
Please check all that apply.

Thank you for your interest in Diabetes Wellness Coaching with diaVerge Diabetes! 

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