Autoimmune Membership Application
This is mandatory in order to be considered for membership; it will take you about 10-15 minutes to complete. This will help me understand your autoimmune journey and help me curate relatable content through our support group and group coaching calls.
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Today's Date: *
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Full Legal Name + Preferred Name (if applicable): *
Preferred Pronouns: *
Required
Email Address: *
Phone Number: *
Date of Birth: *
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Where do you live? (city, state/country) *
What is your occupation? How many hours/week are devoted to this? *
Are you currently on any medications? (you do not have to disclose this if you don't feel comfortable) *
What is your autoimmune diagnosis and when were you diagnosed? (if undiagnosed, when did symptoms arise?) *
Please check anything in your current daily routine: *
Required
On a scale of 1-5, how important is having a supportive community to you currently? *
Not important
Very important
On a scale of 1-5, how important is having a positive mindset to you currently? *
Not important
Very important
On a scale of 1-5, how important is creating healthier habits to you currently? *
Not important
Very important
On a scale of 1-5, how important are healthy personal relationships to you currently? *
Not important
Very important
On a scale of 1-5, how important is eating healthier to you currently? *
Not important
Very important
On a scale of 1-5, how important is exercise to you currently? *
Not important
Very important
How often do you find yourself in a negative mental state? *
How would you rate your energy level over the last 2 months? *
Very low energy - frequently lethargic
High energy - feeling good!
Check off any symptoms you're currently experiencing multiple times per week: *
Required
On average, how often do you exercise? (over the last 2 months) *
On average, how often do you journal? (over the last 2 months) *
On average, how often do you meditate? (over the last 2 months) *
On average, how many balanced meals and/or snacks do you have per day? (over the last 2 months) *
How mindful are you of what you eat on a daily basis? *
What interests you most about The Wellness Method membership? *
Required
Are you interested in 1:1 coaching calls? *
Would you like to schedule a 1:1 call prior to your membership starting? *
Now I have a few questions that require a written answer...bear with me!
Are you aware of any food sensitivities or allergies? *
Are you CURRENTLY working with any other practitioners or are you on a specific diet, treatment regimen, etc.? *
such as naturopathic doctors, psychiatrists, acupuncture, etc. (write N/A if not applicable or if you prefer not to answer)
Please list any PAST programs, diets, holistic treatments you have done and/or any practitioners you have worked with & list approximate dates: *
such as naturopathic doctors, psychiatrists, acupuncture, etc. (write N/A if not applicable or if you prefer not to answer)
What is your WHY? Why do you want to be part of this autoimmune community? *
How did you find out about The Wellness Method membership?
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What are you looking for the most guidance with? *
Do you have any questions? *
Is there anything else you'd like me to know prior to me considering your application? *
Membership is billed monthly through a subscription plan and you can cancel at any time, however there is a 30-day notice policy. Monthly membership is $155 (locked in for life regardless of price increases). By submitting this application, you are expressing interest in membership, however you are not obligated or accepted until Rachel Albo reaches out to you personally to confirm.
Once confirmed, you will be sent a membership agreement and given access to the following resources: private support group, client resource drive, group coaching calls, and discounted 1:1 coaching calls (optional).
I am excited to consider you for membership to The Wellness Method! Please type 'I'm ready!' in the box below to confirm that you have filled out this application to the best of your ability and have read & agree to the above statements. *
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