Please answer the following questions so I can be as helpful as possible on our call - Thank you!

What brings you here today? *

I'm sleeping poorly

I feel tired all the time / low energy

I'm bloated and uncomfortable

I struggle with irregular periods

I have a known thyroid or auto-immune condition

I have trouble losing weight

What specific changes do you want to see? (select all that apply) *

Increase my energy

Sleep better

Fix my cycle

Decrease bloating / bowel movements

Improve my overall health

Lose weight and keep it off

Increase my activity level

Feel empowered to be my own health advocate with my doctor

Make a plan for dealing with my autoimmune condition

Why is it important to you to make these changes in your life right now? *

What have you tried in the past to solve this problem? *

What’s the main obstacle stopping you from reaching your goals on your own? *

How quickly are you looking to get started? *

I'm ready to change my life NOW!

I want this, but I'd like to wait a few weeks before starting.

I'm just shopping around and not ready to get started.

How committed are you to getting help and making these changes? *

I am determined to find answers and change my life

I'm not sure what my steps should be, I'm in information gathering mode

I will do anything at this point

I'm excited to speak with you! Please confirm the below statement: *

This means everything to me, I will 100% be on the call! However, if there is an emergency - I will let you know and reschedule with as much notice as possible.

First Name *

Last Name *

Email *

Phone (Optional)

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