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Healin' Guts + Shakin' Butts Waitlist Application
Please fill out the fields below to send in your application and join the waitlist for the next launch of Healin' Guts + Shakin' Butts with HAN!
*By adding your name + email address to this form, you are agreeing to be added to the HAN Newsletter. No spam here! Just free gut health + digestion tips.
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First and Last Name
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Your answer
Email Address
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Your answer
Date of Birth
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What country do you live in?
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*We are currently able to work with clients in countries within North America and the EU.
Your answer
How did you hear about us?
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Instagram
Facebook
Friend/Family Referral
Google Search
Youtube
Other:
What prompted you to reach out to us at this time?
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Your answer
Briefly list (in order of importance to you) your top 3 health goals.
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For example: 1. Bloating 2. Constipation 3. Skin rashes
Your answer
How has your life been impacted by your current health concerns?
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Your answer
What have you tried to address your health concerns?
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(i.e. diet, supplements, other programs or practitioners)
Your answer
What do you think has prevented you from being successful at accomplishing your goals?
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Your answer
How much money have you spent dealing with your current health issues in the last year?
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(Keep in mind copays, medications, supplements, other programs, missed days of work, etc.)
Your answer
How much time do you currently spend working on your health?
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This can be per week, day, month - just be specific! (Keep in mind appointments, online research, worrying/stressing, etc.)
Your answer
What are your top health goals for the next six to twelve months?
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Be as specific as possible! (i.e. clear up my skin, have more energy, have daily regular bowel movements, eliminate abdominal pain, reflux, bloating, etc.)
Your answer
Do you eat meat, fish, poultry, or eggs? If not, please explain why and let us know if you are willing to (re)introduce animal products for your health.
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Your answer
Please describe when and what you eat on a typical day. (Breakfast, lunch, dinner, and snacks)
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Your answer
Are you capable and willing to cook meals for yourself?
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Yes
No
Other:
Do you believe it is possible for you to reach your goals?
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Absolutely!
I think so...
No I don't
Our individualized approach has cultivated life-changing results for many clients in as little as three months. However, it requires both an emotional and financial investment from you. How ready are you to invest in improving your health right now?
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I don't think I can handle this investment at this time
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I AM SO READY!! Count me in!!
Are you willing to devote 1 - 1.5 hours per week to learning new information that will help you hit your health goals?
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Yes
No
Other:
Our program includes specialized gut microbiome testing with personalized supplement recommendations that vary in cost depending on the individual. Supplements are an additional cost of around $200-400 per month for a few months, with the goal to get you off as many as possible to sustain your newfound health.
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I understand and can manage the additional cost for a few months.
I understand, though I cannot cover this additional cost each month.
Other:
Please note that enrollments for HGSB opens up 2-3 times per year. We have a limited amount of spots for students each round and spots fill up fast. If you are *very* interested in joining and want to secure your spot in the next round of HGSB with a deposit that goes towards your enrollment, please check "READY" below and we will do our best to reach out to you ASAP.
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READY
NOT SURE
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