beauty + wellness + lifestyle

Apply here

First name*

Last name*

Email*

Phone

What are you interested in?

Apply for Case Study

1:1 Nutrition Support

Discuss working together in the future

If the spaces for the Case Study are filled, would you like to be added to a waitlist?

yes

not yet

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

If your symptomolgy is a good fit, are you willing to have a 20-30 minute zoom/phone call to discuss your needs/hopes/goals for consideration of case study?

yes

If you are not chosen for the case study, would you like to work together in the future?

yes please contact me

not at this time

WORK WITH ME

HOLISTIC NUTRITION

BOOK A HAIR APPT

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HAVEN LIVING

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HELP

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SHIPPING & RETURNS

CONTACT

havenlivingshop@gmail.com

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