Action Plan Form

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Action Plan Form

Are you lost in where to start? Are you struggling with your period and fertility? Yet you don't want to commit to the NFM just yet. Get on this 30-min or 60-min call with me to discuss your health history and how to start taking action towards optimizing your health and fertility.

This is the perfect call to get to know me and see if we are a good fit. Plus, you will receive a summary email of everything we discussed and any useful PDF or other resources to help you get started on your journey to optimal health.

The investment is $177 CAD for 30-minutes or $333 CAD for 60-minutes.

Once you have completed the form I will send you an invoice for payment. And once you have completed the payment I will reach out to you via e-mail with the needed scheduling link to book the call.

I look forward to chatting with you soon!

Rani xx

Email *

Contact Information

Full Name: *

Phone Number *

Only used if unable to connect to Zoom Call.

What is your location? *

City, Province/State, Country

How did you hear about me? *

Did anyone refer you?

What is your Instagram handle?

Action Plan Qs

Which call option do you require: *

30-min Consultation ($177 CAD)

60-min Consultation ($333 CAD)

Describe what you are struggling with and what you want to make sure we touch on in this call: *

I recommend 3 goals/topics you want to touch on. List as much as you want as it will put a whole action plan together. I will do many best to touch on each one, if time permits.

What have your cycles been like? The more detail the better. *

How long are your cycles? Are they regular or irregular? Has your period gone missing? Do you have PMS or any other health conditions/diagnosis? Are you on hormonal birth control or just come off?

What are your period and fertility goals in the next 12 months? *

What has kept you from achieving what you have written above? Be honest *

Any additional comments you want to leave for me before our call:

Please check ALL of the following to confirm you understand: *

I have read and understand everything on this page. I acknowledge Rani De Caluwe is a natural health practitioner and does not diagnose, cure, or treat any illness or disease.

I understand that the payment made for the service is non-refundable and by booking this appointment you agree to this.

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Thank you for taking the time to complete the form!

You will receive an invoice within 36 hours upon submitting the form.
I look forward to chatting with you soon!

Rani

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