Gut Rehab Intensive Application Form
Thank you so much for trusting me with your health! Once you submit your application for Gut Rehab, you will receive a response within 7 days. The first step is a short call with Ashley to confirm you are a good fit for the program and discuss your timeline for getting started. 
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First name:
Last name:
Age:
Email address:
Where do you live? (city and country)
How did you hear about me?
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What are the main issues you're hoping Gut Rehab will help with?  Let us know about anything you've been diagnosed with and/or discomfort you are experiencing currently.
What have you already tried to help with these concerns? Have you seen your doctor or another practitioner already?
How much do you think you have already invested in trying to solve your health problems? (Practitioners, supplements, books, etc.)
Are you currently being treated for any medical issues or taking medications? If so, please explain.
On a scale of 1-10, how committed are you to making nutrition and lifestyle changes as recommended? Even if it means giving up gluten or coffee?
Herbs and supplements will be a part of your custom protocol - these will be shipped to you. Are you comfortable using capsules/tinctures/teas?
Is there anything you are not willing to do or that would stand in the way of you getting amazing results?
Do you believe that your mindset is going to play a key role in your healing?
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Are you a data-driven person who loves testing and numbers? Or a sensitive soul who uses intuition and feeling?

Is there anything else about you I should know to best support you?
Gut Rehab Intensive is an all-inclusive gut health program which includes initial and follow-up testing as well as herbs & supplements for your protocol and ongoing support & resources to address each phase of your protocol over 5 months. Are you ready to invest $6,000 CAD into your health today? (A 6-month payment plan is available.)
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