Gut Reset Program Application Form
We are so pumped that you are ready to join the Gut Reset! The Reset begins April 19.
First and last name:
Your answer
Email address:
Your answer
Where do you live? (city and country)
Your answer
What are the main issues you're hoping the Gut Reset Program will help with? Let us know about anything you've been diagnosed with and/or discomfort you are experiencing currently.
Your answer
What have you already tried to help with these concerns? Have you seen your doctor or another practitioner already?
Your answer
Are you currently being treated for any medical issues? If so, please explain.
Your answer
On a scale of 1-10, how committed are you to making nutrition and lifestyle changes as recommended? Even if it means giving up gluten or coffee?
Choose
1
2
3
4
5
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7
8
9
10
Herbs and supplements will likely be a part of your plan and can cost up to several hundred dollars. We do not earn any income on supplement sales and do our best to secure you the lowest costs available, but are you prepared to pay for these supports in order to follow your protocol?
Yes
No
Clear selection
Is there anything you are not willing to do or that would stand in the way of you getting amazing results?
Your answer
Are you ready to invest $1678 into your health today? (A payment plan is available.)
Absolutely - sign me up!
I'm not ready
Clear selection
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