Application to work together 1:1
This application will help me analyse and assess your personal case and create a recommendation for your quickest path to optimal results.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
/
Day
/
Month
Year
Date
Age
*
What country do you live in?
*
Tell me your skin story to date
*
Example: What skin issues do you have? When did it start? What have you tried so far? Did anything help temporarily? Severity?
Tell me about your overall gut and hormone health
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Example: What symptoms are you experiencing? Ie bloating, irregular cycle, fatigue, hair thinning, PCOS, IBS?
How long have you been trying to clear your symptoms?
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Less than 1 year
1-3 years
4-10 years
10+ years
Are you currently taking any form of contraception right now?
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None (tracking via calendar or app ie Flo/Natural Cycles)
Pill (microgynon, levlen etc)
Coil (copper or hormonal)
Depo Injection
Implant
Other
What specific goals would you love to achieve in the next 3-6 months?
*
Clear on what my acne triggers are and how to resolve them
Able to go out makeup free, confidence bare faced
No reactivity to foods, symptom-free digestion
Skin thats stable no matter what I eat
Skin thats stable even when I'm on my period, or due on
To have regular cycles without excruciating PMS symptoms
Why is now the right time to focus on your health in a big transformative way?
*
Perhaps you have a special occasion coming up ie wedding, looking into fertility and family planning, or you've been symptomatic for so long and want to finally get answers once and for all.
From 1-10 how ready are you to commit time, energy and purpose to your healing right now?
*
Please Select
1
2
3
4
5
6
7
8
9
10
1 - I'm not ready. 10 - I'm 100% ready
How do you currently view investing in your health?
*
I see it as a premium investment, and I am willing to invest in my health
I'm open to investing but need to explore the best fit
I am only looking for low cost/ self guided options right now
I am not ready to invest yet, I am just gathering information about it all
Submit
After you hit submit, you will be sent an invitation email to book in for a free discovery call.
Can't wait to speak with you!
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