Get Synced 1:1 Program Application

1

Your name:* This field is required.

First Name

Last Name

2

Your email:* This field is required.

example@example.com

3

Your phone number:* This field is required.

Please enter a valid phone number.

4

Your age:* This field is required.

5

Your location & time zone:* This field is required.

6

What struggles are you facing when it comes to your health, hormones & cycle* This field is required.Try to give as much detail as possible

7

Are you pregnant or breastfeeding?:* This field is required.

Yes

No

8

Are you on birth control?* This field is required.

Yes, currently taking it

I've recently gone off it

I have been off for more than 6 months

I've never taken birth control

9

How regular is your period?* This field is required.

Like clockwork each month

Fairly predictable

Very irregular

I haven't had a period for 6+ months

10

On average, how long does your period last?* This field is required.How many days do you bleed?

3-7 days

Less than 3 days or absent period

7-10 days

10+ days

11

When was the first day of your last period?

Date

12

Over the last 3 cycles, how painful has your period been?* This field is required.

Minimal pain

Some pain

Quite painful

Debilitating

13

Have you been diagnosed or suspect you have a hormonal imbalance?* This field is required.If so, let me know what hormonal imbalance and if you suspect or have been diagnosed

14

Have you ever been diagnosed or suffered from other health concerns aside from your hormonal health?* This field is required.If so, what are they?

15

What are some symptoms that you would like to work on with me?* This field is required.

17

What have you done in the past to try and address your symptoms?Let me know the approaches you have tried, or previous experiences with health care professionals.

18

What would it look and feel like for you to have healthy hormones and manage the symptoms you've told me about? * This field is required.Tell me everything from a physical, emotional, and soul standpoint!

19

Are there any other things that you would like to work on aside from your cyclical & hormonal health that you think I could help you with?This can be anything from other health concerns to mindset, nutrition, career, or fitness goals!

20

Why is now the time to get help with me? * This field is required.

21

I am only available to work with women who are committed to prioritizing their healing. I don't want you to waste your money or either of our time if you are not committed to your health. This is not so say that their won't be ups and downs throughout the program, but I need to make sure that you will be conscious, intentional, and committed to the program so that you will genuinely get the most out of it. * This field is required.

HECK YES I'M COMMITEDI'm not a good fit

22

Due to high demand, there may be a waitlist for 1:1 programs, how quickly would you like to start working with me if accepted into my 1:1 program?* This field is required.

Immediately

Within 1-3 months

Within 3-6 months

In 6+ months

23

Which payment plan feels like the right fit for you at this time?* This field is required.Investment for personalized 1:1 programs start at $2500USD .

Pay in full

3 part payment plan

24

After you complete this application you will be given a link to schedule a 20 minute discovery call in which I will be calling you at the number you provided. Please ensure you show up to your selected time. Do not apply if you have poor communication habits or are not ready to get started. I respect you and your time and ask that you respect mine too.* This field is required.If I have additional questions or don't think you would benefit from my personal support I will notify you as well.

I'm 100% ready to get started!I'm not a good fit.