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Discovery Call Questionnaire

Fill out this consultation request form to share about yourself before our call.

First Name *

Last Name *

Phone *

Email *

Occupation *

State *

Please tell me where you are in your healing journey. *

I am at the very beginning of my healing journey.

I've already done some healing work.

I've done a lot of healing work, but I'm ready to explore more.

Choose up to 3: What are you struggling with the most? *

Nervous system dysregulation

Irritability with kids/family

Anexiety/Depression

Panic

Worry/fear

Betrayal

Unforgiveness

Anger

Shame

Boundaries

Grief

Codependence

Stress/overwhelm

Fatigue/exhaustion

Chronic pain

Sleep disturbances/insomnia

Hormone imbalance

Gut issues

Skin issues

Other physical symptoms

Other

In as much detail as possible, please describe what you hope to gain from the Mind-Body-Spirit Healing program. *

What is your biggest obstacle in achieving your health goals? *

How committed are you to your healing? *

1 (not very committed)

5 (extremely committed)

Who makes the decisions about your health?

Me, alone

Me and another person (spouse, parent, etc.)

Another person

How did you hear about me?

Because of the utmost care and consideration to your individuality and the personalized 1:1 care and attention I give to my clients, working with me is a 4-figure investment, for a minimum of 16 weeks. This is not a quick fix because we are working on sustainable lifestyle changes to last your whole life in order to achieve the results you are wanting. Should this be a good fit, are you willing and able to make a financial and time investment into your health? This question is required.* *

Yes, absolutely!

Definitely not.

Anything else you'd like me to know?

Guiding women to holistic wellness through faith-integrated functional medicine.