Your FREE Discovery Session Application
Welcome! Fill out the form below to apply to work with us. Please note: This application is only for those who are serious about taking control of and investing in their health.

Once your application is received, we will review it and if you are a good fit, we will send you a link to book your free Discovery Call. During this FREE 90-minute call, we will explore what's been going on with you, where your biggest healing opportunities are and what you should do next to take back control of your health and become your own health boss!

If at the end of this call we decided we are a fit to work together, we will explore what that would look like. (And if we're not a fit, we'll help point you in a helpful direction!)

Please note: We get a lot of requests so we'll do our best to get back to you within 72 hours. Thank you!
Sign in to Google to save your progress. Learn more
What's your FIRST name? *
What's your LAST name? *
What's your AGE? *
What's your EMAIL address? *
What's your PHONE number? *
Where do you LIVE (country or state)? *
What do you do for a living? *
What are your main health complaints? *
How often do they bother you? *
How long have you been dealing with these symptoms? *
On a scale of 1-10 (10 being the most DISSATISFIED, how dissatisfied are you with your health? *
Satisfied
Dissatisfied
Did something trigger a change in your health? *
Who or what do you think are the biggest obstacles in reaching your current goals? *
What would IDEAL success with your health look like to you? *
Why is it important that you solve this health challenge right now? *
Are you willing to commit to 6-12 months  to solve your challenges? *
How committed are you to make changes to address your health complaints? *
Not at all committed
The most committed
What have you done so far to try to address your health complaints that has or has not worked? *
Are you willing to take supplements? *
How much would you say you have spent on your health (including programs, surgeries, lab work, supplements, co-pays, medications, practitioners, etc.) in the last 5 years? *
Do you have the financial resources to invest in yourself and your health right now? *
Are you willing to invest time and energy into solving your current health issues? *
Are you currently pregnant or breastfeeding? *
How did you hear about me? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms