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Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What is the reason you are reaching out for support?
What best describes you

MarriedSingleDivorced
Do you have children? If so, how many?
Are you currently pregnant or breastfeeding?
What is your diagnosis? Or suspected diagnosis (you can check more than one)

AnxietyDepressionPanic AttacksPMDDBipolarHormone imbalancePostpartum Anxiety/depressionOther mood disorder
Do you have any known Trauma

Little TBig TNone that I know of
Medication (check all that apply)

I am currently taking medicationI want to get off medicationI am not on any medicationI am thinking about going on medication
What are you struggling with the most right now?
What would you like to experience less of? (Check all that apply)

AnxietyDepressionPanicIntrusive thoughtsPainful PeriodsIrregular PeriodsSelf judgementInsecurityShame/guiltFeeling stuckOver eating/ emotional eatingPerfectionismWorrying what others thinkSuicidal ideation
What would your life look like if you were well?
What did your life look like before you got "sick"?
Do you have someone to hold you accountable and support you along this journey?
What do you think is holding you back from being well?
What is your biggest fear about doing this program?
Do you have spiritual beliefs/religious beliefs *please note in the reset there is daily kundalini meditations. If that is uncomfortable for you, you don't have to participate by any means
44 days of the Homecoming we reset. It is an intense 44 days and individuals have to be willing and ready.. is this you?
I understand that the content provided in this program is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions.

This is a mind, body, spirit holistic healing program. There is no quick fixes or bandaid solutions. This is going to require me to change my lifestyle, diet, and my beliefs, that are no longer serving me. This work creates life changing results and is intended to become part of my lifestlye and being. I understand my results are dependent on my level of comittment. This is a 1:1 coaching program that will be with Sherri.

I understand that this is a financial committment, an investment in my health, time and energy to build the life I dream of. I understand the cost of this program is $1,500 CAD. A payment plan is available.

LETS DO THIS!
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