Treat Yourself Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Treat Yourself Application - January Cohort

We want to make sure that the group coaching clinic you'd like to attend is the right fit for what your dealing with.

If you're a good candidate for Treat Yourself we'll email you with an enrollment link on January 7th.

Add TreatYourself@palmamd.co to your contact list to make sure you don't miss our email, as enrollment will only remain open for one week :)

If you're getting Treat Yourself as a gift for someone else, you can skip this application and fill in the box at the link on https://palmamd.co/Treat-Yourself/

Email *

What's your name?

Which group coaching clinic would you like to apply for?

Treat Yourself: Un-Tox (4-month clinic), $1800 usd plus supplement costs

Treat Yourself: Gut Edit (1-month clinic), $700 usd plus supplement costs

Both (in this case, you're applying for Un-tox -- it includes Gut Edit as it's first 4 weeks :)

What’s the main reason you want to do a Treat Yourself group coaching clinic?

What are the top three symptoms you hope to resolve by doing a Treat Yourself protocol?

Do you have any known diagnoses you hope to improve or resolve?

Are you able to take most supplements and medicines without unwanted reactions?

Yes

Can you tolerate sweating, light exercise and normal daily stimuli like loud noise, bright light, things touching your skin, and changes in temperature without experiencing symptom flares or untoward reactions?

Yes

How did you hear about Treat Yourself?

Instagram

YouTube

TikTok

Google Search

X (Twitter)

I know Dr. Palma

Other:

Clear form

Never submit passwords through Google Forms.

This form was created inside of PALMA MD. Report Abuse

Forms