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To book a complimentary clarity call with me to discuss which of my program are best for you, please complete the application form.

Application Form

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Name*

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Email Address*

What City you live in?

Which of the following concerns applies to you?

Medical Diagnosed Endometriosis +/- Adenomyosis

Medically Diagnosed Irritable Bowel Syndrome

Irregular menstrual cycles/ heavy period pain

Amenorrhea (absent/ missing periods)

Belly Bloating

Diarrhea

Constipation

Fertility and preparing to conceive

Polycystic ovarian syndrome (PCOS)

Managing a healthy weight

Small intestinal overgrowth (SIBO)

Current Eating Disorder

Other

Please describe your health concerns here:*

What is your biggest challenge or frustration when it comes to managing your health?*

How do your health concerns impact your life? Personal, family, career or life goals?

What 3 goals do you want to achieve in the next 3-6 months?

How motivated and ready are you to start working on your goals? Please rate yourself from 0-10 (10 being the most ready).*

How Much are you willing to invest in your health concerns, if it means achieving your goals?

Less than 299 Euros

Between 599 Euros

Between 999 Euros

Whatever it takes to help me achieve my goals

How did you hear about me?

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Friend/ family referral

Health care provider referral

Word of Mouth

Other

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Please provide your Instagram handle (preferred) and or phone number in case we cannot get in touch with you via email.

Agreement*

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