Let’s Get Started! Connect with me: FollowFollowFollow Join My Newsletter First Name *Last Name *Email Address *Phone *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweWhat main health challenge would you like to overcome? *Why is this important to you? *What do you feel are the biggest obstacles preventing you from reaching your health goals? *What is motivating you to invest into solving this health challenge? *Do you take direction well? *Please select an option YesNoIs your family supportive of your decision to be healthy? *Please select an option YesNoWhat qualities are important to you in partnering with a practitioner? *What other types of practitioners have you worked with before? *Select all that applyFunctional Medicine PractitionerNaturopathic DoctorNutritionistMedical DoctorMedical SpecialistOsteopathChirpractorPsychotherapistTraditional Chinese Medicine DoctorMassage TherapistPersonal TrainerOtherSelect all that applyWhat programs have you done previously? *Select all that applyWeight WatchersDr. Poon Metabolic DietNoom Jenny CraigKetoPaleo Intermittent FastingVegan / Plant-based Personal Trainer Gym or Fitness StudioYogaMeditation / Visualization Personal DevelopmentSelect all that applyGiven that you have tried other methods previously, what would you like to do differently this time? *In order to improve your health, how willing are you to make the changes required (this includes diet, lifestyle, taking supplements, mindset etc) *Please select an option Extremely WillingSomewhat WillingNeutralSomewhat unwillingExtremely unwillingIs there any other information you feel is important?0 / 180This form will redirect you to another page once submitted.Book my discovery call!Please do not fill in this field. Bring out the best, most beautiful and luminous you! Discover a way to stick to your self care routine with my my Self Care Checklist simply by signing up now! Thanks! First Name Email Subscribe Your privacy is important to me! I will not sell or give your information to any third party. And you can unsubscribe at any time.