The Autoimmune Revolution Application

You may not realize this at the moment, but filling out this form is the beginning of your final journey to getting your health back on track and into remission FAST.

We receive over 20 applications per week. Your time is very valuable, as is ours. We only speak with women who are serious about getting the life changing help they need.

Keep in mind, filling out this form is essentially a screening for one of the exclusive spots into the program. As we need to make sure based on your answers that we can help you and you're ready to get help.

**Once you have completed the application and submitted your answers you will be directed to another page with a link to book a phone call with Justin or his team. Please book the call immediately after completing this application.

The purpose for the call is to figure out what it is that you really want and to identify the things that have held you back from having that life you want.

Consider this a FREE breakthrough coaching call!

Thank you!
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What is your first name? *
What is your last name? *
What is your Instagram Handle? *
Which email address shall we use? *
What number do you want to be reached on? (if international, WhatsApp or Skype) *
What is your age? *
How did you hear about The Autoimmune Revolution? *
How long have you been following Justin (Founder of AIR) and reading/watching his content on social media? *
What inspired you to submit this application?
W​hat is your health condition/diagnosis? *
H​ow many years have you had your illness for? *
What does your dream life look like in the area of health? *
What is your biggest challenge in getting there? *
Why is it important for you to shift this now? *
Are you ready to change this once and for all? *
Thank you for completing the application form! Book your call once you submit your application.

On the next page you will be prompted to book a phone call with Justin. Please do this asap. We're excited to chat with you.
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