VIP Hormone Reset Application Form

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This is the first step in our journey together, so if I think we would be a great fit, I will reach out by email within 24 business hours to let you know the next steps!

PLEASE NOTE:

I accept serious applications only. My time is valuable and so if yours! So please apply ONLY if you're 100% serious about working together to get results with your health.

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Name

First Name

Last Name

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Date of Birth

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Email

example@example.com

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What is your instagram handle?

example@example.com

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Did anyone refer you to Alta Peak Wellbeing?

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Please share your #1 health goal you wish to accomplish in the next 6 months:

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What do you struggle with currently in terms of reaching this goal?

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How would your life change if we were able to significantly improve your health?

Take a minute to answer this question. Think about anything that you are not able to do currently that you wish that you could. What could you do if you felt better?

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Why did you decide to apply to work with Kylie?

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If we find that we are a perfect fit, do you have the budget to invest in a 4 month personalized program, or are ok with a payment plan if you do not?

Yes! I am ready and able to invest in my health now

I am unable to invest in my health right now

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I'm ready to give YOU all the tools for success, but I only work with those that are highly coachable and ready to do the work. How ready and willing are you to invest the time, money, and energy/desire when it comes to reaching your goals? Be specific please.

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If we are a good fit, your discovery call is free, but reserved for those that are ready to invest in their health. If you would like an on-your-own style program based on lab results, please refer to the Epigenetic Hair Scan Test application.

If we decide to work together and you commit to the program and protocol we create, we guarantee results.

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Do you promise to show up and be fully present for your call? (Please do not book if you plan to join the call while in a distracting environment, driving, or in a public place.)

Yes I promise to show up and be present

No, not sure i'll be able to join

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Thank you for filling out this form! I will reach out to let you know if your application was accepted.

Plan on hearing from me soon! Have a great day!