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About
Blog
Podcast
Work With Me
Apply to Work With Me
Packages
How I Work With You
Recipes
Contact
Apply to Work With Me
Work With Me
Please enable JavaScript in your browser to complete this form.
First Name
*
Last Name
*
Gender
Man
Woman
Non-Binary
Gender non-conforming / Gender fluid
Transgender man
Transgender woman
Prefer not to say
Email
*
Cell Phone
*
Business Phone
1. Have you had a comprehensive stool test done in the last 2 months?
*
Yes
No
2. Have you had an adrenal test done in the last month?
*
Yes
No
3. Have you had a food sensitivity test done in the last 3 months?
*
Yes
No
4. Have you done genetics testing? If so, through what company?
*
5. Check all the boxes that apply: What health challenges are you seeking help for (are you wanting solved?)
Weight gain
Weight loss
Better sleep
Better mood
Concentration
Curing digestive issues
Rebalancing hormones and adrenals
More energy
Healing fertility issues
Better libido
You want me as part of your team for addiction recovery
You want me as part of your team for reversing autoimmune disorder
You want me as part of your team for treating Cancer
Healing after Cancer Treatment
Detoxing
Other, please specify.
6. What have you already tried to treat your illness or dis-ease with, and what was your experience like?
7. Do you have a history of childhood or adult trauma?
Yes
No
8. When was the last time you were happy with the combined alignment of your body, mind and spirt?
9. On a scale from zero to five, how comfortable are you "exploring" in the kitchen (new recipes, new ingredients, etc.)?
1
2
3
4
5
10. Do you prefer sweet or salty flavors?
Sweet
Salty
11. Do you have a history of an eating disorder? If so, please describe your disorder/disordered behaviors. Is it currently active?
12. Are you struggling with addiction? If so, what form of addiction? Are you in recovery? How long have you been in recovery? Are you in a space where you feel supported by the people in your life in your recovery?
13. When you get off track, what substance do you reach for?
14. What circumstances cause you to relapse? (I.e. celebration, funeral, weekend, having a bad day, being tired/overwhelmed). What is the emotion happening when you reach for that substance?
15. Do you have ways of relieving your stress? If so, what?
16. Do you have a support system in the house or are you the only one?
17. Have you hit your rock bottom yet?
18. On a scale from zero to five, how important is this life change to you? Why?
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