Name
First Name
Last Name
Email
example@example.com
What interested you about Hair Tissue Mineral Analysis (HTMA)?
Have you had an HTMA test done before?
Yes, within the last year
Yes, more than a year ago
No, this would be my first HTMA
How would you currently describe your overall health and vitality?
Thriving
Managing but not optimal
Struggling and seeking support
In recovery or transition
What areas feel most out of balance for you right now? (Check all that apply)
Energy & Fatigue
Stress & Nervous System
Digestion & Elimination
Blood Sugar & Metabolism
Hormones
Mood, Focus, or Sleep
Immune Resilience
Other
If you answered other, please specify.
How do you typically do with making gradual lifestyle or nutrition changes?
I enjoy experimenting and learning
I prefer simple, step-by-step guidance
I need things to feel gentle and manageable
I’m not sure yet
Have you ever worked with a holistic, functional, or energetic practitioner before?
Yes
No
Some Experience
What is your ideal timeline for starting to work together toward your goals?
Submit
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