Kresser Institute

Practitioner Eligibility Form

Please fill out the short form below to determine if you are eligible for the ADAPT Practitioner Training Program.

First Name:
Last Name:
Email Address
Phone
Active license as a medical professional in your state:
License #
U.S. or International?
U.S. International
State
Country
Inactive medical license: CNS, DC, DDS, DO, DPM, LAc, MD, MFT, ND, NP, OT, PA, PharmD, PsyD, PT, RN, RPh, RD
Yes No
Enrolled in educational program that will confer medical license: CNS, DC, DDS, DO, DPM, LAc, MD, MFT, ND, NP, OT, PA, PharmD, PsyD, PT, RN, RPh, RD
Yes No
Professional certification in health coaching or nutrition studies (from Kresser Institute, ITN, IIN, NTA, FMCA, Bauman College, or similar)
Yes No
Work under the direct supervision of a licensed medical provider (signature of supervisor required)
Yes No
Graduate-level coursework in medical sciences (anatomy, physiology, pathophysiology, etc.)
Yes No
Currently active private practice with a business license, website, and revenue
Yes No
Undergraduate-level coursework in life/medical sciences (biology, chemistry, biochemistry, etc.)
Yes No