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Lets Work Together

Interested in working together? Take a short few moments to fill out some information below. This will give me some knowledge about you and where you are in your journey. Answer with authenticity and a desire for change.

First Name

Last Name

Phone *

Email *

Age *

What service are you interested in? *

THE EMBODIED FOUNDATION

THE INNER JOURNEY

What is your biggest challenge right now? *

FATIGUE/LOW ENERGY LEVELS

BRAIN FOG

DIGESTIVE ISSUES

INFLAMMATION IN THE BODY

SKIN PROBLEMS

ANXIETY OR STRESS

WEIGHT MANAGEMENT ISSUES

WEAK IMMUNE SYSTEM

HORMONAL IMBALANCES

PAIN OR PHYSICAL IMBALANCES

What problems are these challenges causing you?

Do you have any Chronic Health Conditions? *

Are you taking any medications? *

What time do you get to bed, fall asleep, and wake up? *

How often do you feel stressed or overwhelmed? *

RARELY

OCCASIONALLY

FREQUENTLY

CONSTANTLY

How much time can you realistically dedicate each day to a program? *

30 - 60 MINUTES

1 - 2 HOURS

2+ HOURS

What does a typical day look like for you? What do you do for work? What time do you start & finish work? *

What are your energy levels like in the morning, Midday and evening ? Where else are you spending your energy from day to day? Sports, Hobbies, ect. *

On a scale of 1-10, how committed are you to making changes to improve your health? *

Do finances concern you in relation to your goal? *

NO, I AM COMMITTED TO THE CHANGE. THERE IS NO BETTER INVESTMENT THAN MY HEALTH

YES, I AM CONCERNED I WONT BE ABLE TO AFFORD THE LIFESTYLE FOR CHANGE

UNSURE HOW I FEEL AND WHAT TO EXPECT

What challenges do you foresee that might prevent you from fully participating? *

TIME CONSTRAINTS

FINANCIAL CONCERNS

LACK OF MOTIVATION

SOCIAL PRESSURES

CRAVINGS AND FOOD ADDICTIONS

OTHER ADDICTIONS

FEAR OF CHANGE

OTHER

What is your main goal? *

What would it feel like to achieve this outcome? *

Is there anything else I should know about your health or lifestyle that would help me support you? *

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Whatsapp: +447715124203

Email: [email protected]

Lets Work Together

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