Questionnaire

Fill out this consultation request form to share a little about yourself.

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.

In as much detail as possible, please describe what you hope to gain from the Rooted-Rewired-Restored program. *

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

Who makes the decisions about your health? *

Me, alone

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

Another person

Which statement resonates most with you today *

I feel like my past defines me

I feel like I am sometimes controlled by my past

I feel like I am actively healing and reclaiming myself

I feel like I am aligning more with who Christ created me to be

I feel like I am fully living in my Christ-given identity

How did you hear about me? *

Because of the high level of personalized care and support I provide, working with me in a group or 1:1 capacity requires a minimum commitment of 12 weeks. This is not a quick fix, because we focus on deep, sustainable lifestyle changes that lead to lasting transformation, not temporary results or bandaid fixes. Financial investment is $300-1000/month, depending on the level of support you choose. This question is required: If this feels like a good fit, are you willing and able to make both a financial and time investment in your health and healing? *

Yes, absolutely!

Definitely not.

I'm not interested in group or 1:1 coaching, but please send me information on the Rooted Woman Membership

What are you hoping to gain by submitting this form? What kind of support are you looking for? *

Anything else you'd like me to know?

I agree to terms & conditions provided by the company. By providing my email, I agree to receive email messages from the business. By providing my phone number, I agree to receive text messages from the business.

Guiding women to freedom and holistic wellness through faith-integrated mind-body health.