Zoey Shade Wellness

Zoey Shade Wellness

1:1 Functional Nutrition Coaching Initial Interest Form
Full Name

First NameLast Name
Email Address
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Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
By submitting this interest form, you are not committing to services of any kind. This is just for us to determine if this program is a good fit for where you are in your journey, and if my approach resonates with you.
Briefly describe your main health complaints. What has motivated you to seek out care? If we end up working together, we can discuss this more in detail during your first session.
Do you have any diagnosed medical conditions? Are you currently under the care of a physician or other medical professional for this?
How did you hear about us?
Do you live outside of the US or in New York or New Jersey? Please note we cannot offer functional lab services to these areas at this time.
Have you ever been diagnosed with cancer?
Are you currently pregnant or breastfeeding?
Have you ever worked with a functional medicine or nutrition practitioner in the past?
How much time and money have you spent over the years trying to resolve these symptoms on your own?
What have you already tried (either on your own or with another practitioner) that has not worked?
What would the impact be on your life if you were able to resolve these health concerns and finally feel like yourself again?
Functional testing is a key part of this program. Lab recommendations depend on your symptoms, health history, and initial consultation. The cost for initial labs can range anywhere from $400-$1200.
Although everyone's healing journey will be unique, most of our clients find that it takes 6 months to create meaningful, lasting change. Are you in a place where you are willing to commit to a 6+ month health journey?
Anything else you'd like us to know?
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