Apply to Work With Me

Apply to Work With Me

Welcome! If you’re here, you’re likely seeking deeper healing for your hormones/fertility, and a more aligned relationship with your body. This application helps me understand your health history, goals, and the patterns showing up across your five bodies, so I can determine whether a quantum approach is the right fit for you. The more openly you share, the more precisely I can support you!
First and last name:*

First NameLast Name
Preferred email:*
example@example.com
Do you prefer Instagram or Email for me to follow up with you? If Instagram, please drop your IG handle below.*
Would you like to be added to my email list to get exclusive access to quantum health tips, freebies, and discounts on my services?*

Yes pleaseNo thank you
What’s your phone number?*
Please enter a valid phone number.Format: (000) 000-0000.
Please enter your phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Do you know what type of support you're looking for?*
What's your occupation? How many hours a week do you work?*
Have you ever worked with a coach/practitioner in a 1-1 setting or in a group setting? If so, who, what program, and in what capacity?*
What is your number one goal right now in regards to your health and wellbeing?*
How would you explain your current and past efforts to get to your goal?*
How much stress are you currently experiencing?*

So much stress it's unbearableA good bit of stressNot very much stressNo stress at all
When is the first time you see the sun or get outside for the day?*
What is your first beverage of the day?*
What time is your first meal of the day?*
How sedentary are you during the day?*
What time do you wake up and go to bed each day?*
In your opinion, what is stopping you from having the health of your dreams?*
In your own words, how are your current habits/lifestyle hurting you/your life?*
Are you currently seeing a therapist? Have you seen a therapist before? If not, are you open to exploring therapy?*
Which of the following physical symptoms are you experiencing?*

Past miscarriageInfertilityFatigueBloatingInability to lose weight when dietingAnxietyDepressionConstipationDiarrheaHigh stressFood sensitivitiesHeavy periodsPainful periodsIrregular periodsHair loss or thinningAcne, eczema, or psoriasisHeadachesTrouble sleepingRecurring sinus congestionSugar cravingsBrain fogEndometriosisOther
Do you have a supportive spouse, significant other, or family/friends who support you in reaching your health goals by understanding and aligning with your personal health mission?*
What is the maximum you're willing to invest in your health? This is a TOTAL amount, not monthly. Please think and be honest.*

$100 - $500$1,500 - $2,000As much as I need to
Do you have any questions about my personal journey or about the practice?*
Should be Empty: