HTMA Review Application
Thank you for your interest in working together. Please fill in this form with plenty of detail and I will be in contact with next steps.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone number
Gender
*
Female
Male
Age
*
Are you
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Pregnant
0-6 months postpartum
6+ months postpartum
Trying to conceive
Other
What are your current health concerns & symptoms?
*
What have you tried to support these concerns? Please include types of practitioners seen (if any)
*
What do you hope to gain from working together?
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Please select all that apply
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I eat predominantly wholefoods
I eat animal products
I eat at least three meals per day
I am mindful of environmental toxins & do my best to limit my load
I prioritise rest and sleep
I spend time outside daily
I move my body weekly
I have awareness over my stress levels
I am willing to make dietary & lifestyle adjustments to support my health
I am willing to invest in supplements (as required)
You understand there are no 'quick fixes' with my approach and mineral balancing takes time, commitment, and responsibility
*
Please Select
Yes
No
Is there anything else you want me to know?
Do you wish to pay in installments?
*
Please Select
Yes
No, I will pay in full
Submit
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