Coaching Inquiry
.
Name
*
Legal first name
Last name
City
State/Province
Email address
*
example@example.com
What are your current health struggles? (ex. severe PMS, irregular periods, painful periods, hormonal acne, chronic fatigue, bloating, etc)
Do you have any medical diagnoses that I should be aware of? ex. PCOS, endometriosis, depression, diabetes, cancer, hypertension, hypothyroidism, IBS, etc.
What are some limitations or barriers you have when it comes to investing in your health? (ex. money, time, energy)
Are you prepared to commit/invest financially, emotionally, mentally, and physically into improving your health?
Yes
No
If so, when are you able and ready to start working with me?
Right away
In 1-3 months
In 3-6 months
Other
If "Other", please specify
Please verify that you are human
*
Liana Van Pelt, NTP
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