Application Page

Apply to Work With Me!

Something inside you knows it’s time for a change — and this is where it begins.

Fill out the form below so I can learn more about what you’re navigating and what you’re hoping to shift. Once you hit submit, you’ll be automatically directed to book your free 30-minute discovery call so we can explore the next best step — together.

You don’t have to do this alone anymore. Let’s get to the root.

Name

Phone Number

Age

Referred by/How did you hear about me?

What brings you to this call? This call is a chance for us to learn more about you and your goals, and to ensure we’re the right fit for your care. Please briefly share what you’d like to support with -whether it’s hormones, thyroid health, fertility, perimenopause or something else.

Have you worked with a functional medicine health coach before?

a. Yes

b. No

What is the main area of your health that you’re hoping to improve or get support with?

What has been the biggest obstacle in hitting your health goals? (

So far in your journey, what have you tried to fix these symptoms/complications? (

If we could wave a magic wand and help you feel your absolute best this year-physically, mentally, and emotionally- what would that look like for you?

How do you prefer to be supported in your care?

Do you know we operate as a concierge practice (no insurance billing, high-touch care model)?

a. Yes

b. No, I’d like to learn more.

What is your preferred level of communication and access to your provider/coach?

Why is it important that you solve these health challenges right now VS. a year from now?

When it comes to making your health a priority, what level of investment feels aligned for you? (**the lowest option should be the cost of your deep dive and your full program should land right in the middle of all the options you provide)

$500-$2000

$2,000-4,000

$4,000-6,000

$6,000-10,000

$10,000+

Is there anyone else (spouse, partner, or parent) involved in your decision-making process? If so, will they be attending the call?

a. Yes

b. No

How soon are you looking to start working with us?

Immediately

Within the next month

Within the next three months

I’m just exploring options for now

What is the primary reason you are seeking concierge care over traditional care?

More personalized attention

Access to longer appointments

Holistic care and support

Convenience and flexibility

How committed are you to making lifestyle changes to reach your health goals?

Fully committed, willing to do whatever it takes

Somewhat committed, but need support

Looking for guidance, but not sure if I can fully commit yet.

Apply to Work With Me!

Something inside you knows it’s time for a change — and this is where it begins.

Fill out the form below so I can learn more about what you’re navigating and what you’re hoping to shift. Once you hit submit, you’ll be automatically directed to book your free 30-minute discovery call so we can explore the next best step — together.

You don’t have to do this alone anymore. Let’s get to the root.

Join Our Free Trial