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New Client Inquiry
Thank you so very much for your interest in working 1:1 together! I value every single client I work with and love being a part of their health and healing journey. Please take some time to fill out this form so I can learn a little bit about you! I will reach out to you after completion with details on booking your complimentary Wellness Reset Consult.
I am not able to take on international clients or clients residing in the following states: New York, New Jersey, and Rhode Island.*
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Email
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Colleen Kurtz, LCSW, FNTP, MRWP, CIMHP
Functional Nutritional Therapy
I look forward to connecting with you and supporting you on your healing journey!
First and Last Name
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Email Address
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Phone number
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Do you live in NY, NJ, RI, or outside of the US?
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What timezone are you in?
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How did you hear about Colleen?
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What are your current health concerns or struggles?
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What would optimum health look like to you?
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Your answer
Have you completed any previous functional testing, protocols, medications, tried other therapies? If so, provide a brief description of what avenues you have already tried
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On a scale of 1-10, how committed are you to changing diet and lifestyle habits to reach your health goals?
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1
2
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10
If there is anyone that needs to be involved in the conversation regarding cost of services, please include them in the call when we meet.
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Thank you for taking the time to complete this form. I will reach out after reviewing to schedule a Clarity Call with you!
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