1:1 Mentorship/Health Program
Please complete this form with due care and vulnerability.
This is a safe sharing space that allows us to share information to best support you in your journey.

Please know that 1:1 work together requires a commitment from both of us, it's an energy exchange which does require a time and financial investment to be made, but that reflects your readiness to up-level your life and choose to access all that you can for yourself!

Mentorship programs for women are typically for a period of 12 weeks together with weekly sessions; achieving some life-changing results and transformation in the areas of health, self, relationships and business goals.

I work with you in a multi-faceted container, meaning you are able to access all of my modalities in the areas of your life that they would best serve you.

Please only apply if you are genuinely ready to begin work together.

Note: currently one-off health consultations are unavailable outside of Women's mentorship programs (children's/family wellness consults can be arranged, see children's section of the website).

I'm so glad you are here and look forward to supporting you. Katie x

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Email *
Your Full Name *
D.O.B? *
Phone Number? *
Mailing Address *
I'd love to hear about YOU. Tell me a little about yourself, your current relationships, who you live with, your current season of life, what you love doing, what you love about yourself and perhaps a few of your favourite things. *
Do you have an area of focus that you are really desiring to work on? Please let me know if your focus is health, business or personal related and a little bit about that focus. *
Do you have a current goal around this priority? i.e. I would like to feel 'x', or a particular timeline or milestone you are aiming for?
What do you feel are your greatest limits or limiting beliefs to obtaining this goal?
Please tell me a little about both your current state of health and also any previous medical history. Please list here any diagnosis, previous conditions and also symptoms such as sleeplessness, anxiety, digestive concerns, skin health, hormonal wellness etc *
Medications - Please list any pharmaceutical medications you are taking, and dosages. *
Supplements - Please list any supplements (nutritional or herbal) that you are taking and dosages. *
Are you pregnant or planning a pregnancy? *
Do you suffer from any allergy or intolerance? What symptoms do you experience when in contact with this allergen? *
How much of you self potential do you feel you are reaching? *
I'm barely accessing my potential right now.
Up-leveling everywhere!
What is it in particular that has you excited to work with me? In what ways do you feel I am right to work with you? *
What previous help or guidance have you sought for this particular concern or goal? Tell me more about that, what worked/didn't, why do you feel that was the case? *
Please share with me your current availability for session times (days of the week/times of day). All Sessions are currently hosted via Zoom. *
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