Apply to work with Elly Michelle
Thank you for your interest in working with me to understand and address the root cause of your health concerns. My focus is helping women feel connected to their fullest expression of health and radiance! Please complete this form to give me a sense of your health concerns and goals. If I feel that you might be a good fit to work with me, then the next step in the application process will be an introductory phone call with me. While you will absolutely get value out of this call, please understand that there are NO QUICK FIXES when it comes to health. Optimizing health is a process that takes TIME, your full dedication and your commitment to the long game. The best results take a minimum of 6-12 months. Once you complete this form, if I think you are a good candidate to work with me, you will receive an email within 24-48 hours to schedule an introductory phone call. Please understand that this call is NOT an official consultation and this call does NOT commit you to working with me. It is an opportunity to have a conversation about where your health is currently, how you want to see your health improve, what your next steps might be and how I can support you in moving toward your vision for your health and life. On this call we will explore whether moving forward with working together feels aligned for us. I look forward to supporting you in feeling clear and confident about the right next steps for you.
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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In what city/state do you live (or country if outside the US)?
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Age
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How did you find Dr. Elly?
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What are you struggling with the most when it comes to your health?
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How long have you been dealing with the health challenges you described above?
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How are your health challenges impacting your life currently?
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What have you tried in the past to address your health concerns? What worked, what did not work?
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Have you ever worked with a Naturopathic Doctor in the past? If so, what was your experience?
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Have you ever done it any lab testing (blood or functional/specialty testing like stool, hormone, food sensitivity)?
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If you no longer were struggling with these health challenges, how would your life be different? How would YOU feel different?
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List the top 3 ways you would like to see your health improve over the next 12 months:
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Why is it important to you to truly figure out what is going on in your body rather than finding a "quick fix" or seeking ways to mask your symptoms?
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On a scale of 1-10, how committed are you to investing TIME, MONEY AND ENERGY into getting support and strategy to improve your health and wellbeing? (1 = not committed at all, 10 = I'll do whatever it takes!)
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How much are you able and willing to invest in your health right now?
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$1400-$2700
$2700-$4700
$4700-$5900
Whatever it takes to heal!
I don't have the ability to invest right now
If offered, I realize I will be booking a REAL TIME 1:1 call with Dr. Elly Michelle. I promise to honor and respect her time by showing up for the time that she reserves for me.
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Yes, I'll be there!
I understand that I cannot use insurance to cover the cost of services with Dr. Elly. I am able and willing to invest in my health out of pocket.
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Yes, I understand that to work with Dr. Elly I will be paying out of pocket.
Submit
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