Set Free Program Application
6 month holistic health coaching
Name
First Name
Last Name
Email
example@example.com
Phone Number
*
Format: (000) 000-0000.
What are your biggest struggles with your health right now? Be as descriptive as possible! I want to hear it all.
What have you tried so far (testing/labs, doctors, medications, diets, heavy metal detoxes, acupuncture, etc)?
What are some roadblocks you're currently facing that you perceive are holding you back from receiving results?
What are 3-5 words that describe you?
Tell me a little bit about your life:
What are some big T (childhood neglect, witnessing a crime, a painful breakup/divorce) or little t (pet dying, sports injury, a move) traumas you've faced that you think may be affecting your health outcome?
Why is NOW the time that makes sense for you to work with a health coach?
What are your goals and intentions for our time together?
Are you willing and ready to invest ($2,000) into this journey?
*
YES! I'm ready to go all in and PIF!
No, I can't do that.
Yes, I'd like to but would need a payment plan
Submit
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