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beauty + wellness + lifestyle
Apply here - AUGUST INTAKE
First name
*
Last name
*
Email
*
Phone
This journey is not fast, easy or a quick fix. To be fully aware of the time investment required, please ensure that you have checked the boxes, acknowledging you are aware of the time needed invest in this process;
Lifestyle Assesment Form 45min-90min
Nutritional Symptomatology Form 45min-90min
Intake Appointment 60-90min
Follow Up Appointments 60min
List your top 3-5+ symptoms in order of importance:
*
Please list any diagnosis, findings or explaination you've learned in regards to your symptoms.
What do you hope to accomplish with this journey?
*
Please choose the following options that fit your current lifestyle.
Smoking
Drugs or Alcohol
Stress
Regular Exercise
Lack of sleep
Prioritizing Sleep
Fast Food
Standard American Diet
Whole Food Diet
List any Medications, Vitamins or Supplements you take regularly:
How often do you eat, average times of day and consistency:
*
Typical bedtime and hours of sleep:
*
What are your biggest barriers to heal or seeking support?
Is there anything you want me to know about you, your life experience, your body or your emotions that you want to feel seen heard or understood?
How committed are you to the process on this journey?
Very - I need support
Still collecting information
Unsure of what's involved
Struggle with consistency
Looking for short term support
I would like to set up a 15 minute free consultation by either zoom or by phone.
Zoom
Phone Call
Other
Apply Now
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