Consultation Form

Consultation Intake Form

Help us tailor your consult by sharing your motivations, habits, and hopes. Please answer honestly so we can best support your individual needs.
Welcome! This intake form is designed to help us understand your unique goals, challenges, and preferences for your journey. Your honest responses will allow us to provide the most relevant support and resources. All information is confidential and used only to personalize your experience.
Increased energyBetter sleepBrain healthHormone balanceCuriosityOther (please specify)
Brain fogMood changesDigestion issuesLow energySugar cravingsInflammationMemory concernsSleep problems
Mostly whole, unprocessed foodsBalanced but includes some processed foodsFrequent takeout or convenience foodsIrregular meal patternsFollowing a specific diet (e.g., vegan, keto, etc.)Other
I move my body daily (walk, stretch, exercise, etc.)I move a few times a weekI need motivation to move moreI regularly engage in creative activities (art, music, writing, etc.)I want to be more creativeOther (please specify)
Describe the changes you hope to experience during this 4-week journey.*
Is there anything else you’d like us to know to better support you? (Optional)
Name*

First NameLast Name
Email*
example@example.com
Should be Empty:

Consultation Intake Form