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Apply to Work with Amanda Koch, NTP, NCPT
Thanks so much for being here! This is the first step in partnering with Amanda for individual wellness services. Once your application has been reviewed, you will receive an email with next steps.
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First and Last Name
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Email address
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Phone number
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Do you live in the United States?
Yes
No
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If yes, which state/time zone do you live in?
Your answer
How did you find Amanda?
Referral
Google
Social Media
Podcast
Blogpost
Other:
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Which services are you interested in?
One Hour Pick My Brain Session $250
One Month Comprehensive $480
Three Month Intensive $1200
Lab Interpretation $250
Other:
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Have you completed any labs or bloodwork that you would like to share with me? Or are you interested in having these done?
Your answer
Which labs are you interested in?
Bloodwork
Organic Acid Test (urine)
Mold/Mycotoxin Test (urine)
Total Toxin Test (urine)
Dutch Hormone Test (saliva)
Gut Zoomer (stool)
Tickborne 2.0 (blood)
Other:
What are your top 3 current health goals?
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What are your top 3 current health concerns/issues? (brief answer please, more to come with health questionnaire)
Your answer
What symptoms do you experience on a daily/weekly basis that you want improvement with?
(brief answer please, more to come with health questionnaire)
Your answer
How committed are you to making significant changes in your life for the sake of your health?
Your answer
Restoring the body to optimal health takes time. Are you up for truly committing the time to make real change and to see results?
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Have you worked with any nutritionists/therapists/coaches in the past? If so, please give me an honest review of that experience.
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How soon do you want to get started?
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Are you currently or have you ever been vegetarian or vegan? If so, for how long?
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How willing and/or able are you to invest financially in these services, quality food, supplements, and any other needed items?
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Tell me a bit about your personality. Rule follower, rebel, questioner, etc. If you've ever taken a personality test like the Enneagram or 4 Tendencies, please share! All of this info makes it easier for you and Amanda to work well together.
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Anything else you want to share?
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