Package #2 Application

Please complete the following form to the best of your ability so we may confirm whether or not you are a good fit for this service.

Name *
Name
Address *
Address
Have you worked with other health practitioners in the past? *
Do you understand that you are applying for a 4-week support package for $897 USD?
Do you understand that changing your health and lifestyle can take 3-6 months to achieve your goals? *
Do you understand that while I will lovingly support you, that you may receive some tough love through this process? *
Please complete the following questions by rating them *
Please complete the following questions by rating them
I am very committed to my health
It's important for me to invest in my health
I am open to making changes to my nutrition
I am open to making changes to my current lifestyle (Please note in most cases this will require mindset shifting)