Request edit access
Apply for Gut Alchemy
Functional Gut Repair Program - 2 options

*Option 1: 5x Months, 9 sessions, 2x functional lab tests: the GIMAP Digestive Panel and HTMA (hair tissue mineral analysis) to reach your personal digestion, energy & metabolism health goals.

*Option 2: 6x months, 12 sessions, 5x labs: GIMAP, HTMA, Dutch Hormone Test, TotalTox Burden, Functional Bloodwork w/Full Thyroid Panel to reach digestion, energy, metabolism + more health goals.

The GIMAP can pin-point healing opportunities for digestive function, energy, metabolism, weight goals, hormone health, skin, autoimmunity, hair health, joint health and even unexpected wins. The GIMAP is the most comprehensive digestive panel that tests for H. pylori, opportunistic bacteria, potential autoimmune triggers, immune function, enzymes, gallbladder function, estrogen detox, candida, parasites and more. 

The HTMA -- hair tissue mineral analysis - measures a 3 month average of mineral levels and heavy metal exposures, which influence energy, hormones, metabolism, thyroid function, adrenal health and more. This lab shows us what state the metabolism is in, stomach acid levels, iodine status, as well as what natural supplements and foods would be beneficial to eat to improve the metabolism.
Email *
Name *
Tell me a little about yourself (age, location, occupation, favorite food):
What is your main health symptom? How often does it occur? How long has this been going on? How does this affect your life or what does it prevent you from doing?
Describe your Top 3 Health Goals:
List any previous diagnosis (i.e. Type II Diabetes,
Hypothyroidism, PCOS, Crohn’s, IBS, etc.)
What have you tried in the past to reach your health goals? such as supplements, modalities, therapies, chiropractic, acupuncture, colon hydrotherapy, etc. What changes or improvements were noted?
What kind of diet is currently being eaten (e.g. Standard American Diet, gluten-free, dairy-free, low-carb, Paleo, organic, vegetarian, vegan, fasting, keto, etc.)?
Are you serious about reaching your health goals? *
On a scale of 1 to 10 how serious are you about solving your #1 health goal? *
Required
Note any relevant historical issues (mold, water damage, major stressful event, major surgery, accident, trauma, metals, environmental chemicals, dental or oral health issues, amalgam fillings, post vaccine complications, etc.) *
What is your greatest barrier to reaching your health goals? Who or what (fear, money, time) may stop you from completing your program? Who will support you?
What do you expect to achieve from working together? *
If I suggest testing your home of mold, will you do it?
Clear selection
Any other special factors (lifestyle, environment, sleep, exercise, job, risky behaviors, marijuana, alcohol or drug abuse, etc.) that should be noted?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms