Welcome! What is your first and last name?

What is your phone number?

What is your time zone, and the best time to reach you? 

What is your best email?

Your child(ren)'s name(s) and age(s)? (If you are here for your child/children)

What is your date of birth and your child(ren)'s date of birth (if applicable)?

What brought you here? Tell me about the current symptoms you and/or your loved one(s) are experiencing.

Have there been any diagnoses? If yes- when, who and for what?

Are you just getting started on remedying your current situation? If no, can you share with me what you've already done to improve your current situation? What types of intervention have you tried? What has worked? What has not worked?

Have you done any testing? If yes, which tests, how recently, and what were the general results?

Are you or your child currently taking any prescriptions or supplements? If yes, please list them including brand.

Please describe what you and/or your child are currently eating for breakfast, lunch, snacks, dinner and beverages in a typical week.

Are there any known food allergies or intolerances? If yes, please list them.

What specific changes and results are most important to you?

Understanding your investment capacity helps me to know whether or not this is a good fit for you and also helps me to tailor my coaching, lab testing recommendations, and support to fit your needs. Please share an estimate of your budget for 1:1 coaching, lab testing, supplements, and ongoing support. Feel free to provide a range or select from the options below:

Do you have any questions or need clarification about anything related to participating in this program?

In the next six months, what goals would you like to reach with our program?

What would success look like for you?