Abundant Living course Application
Thank you for your interest in growing yourself and improving your health. This will help me better understand your health needs as we work together.

I'll contact you to schedule a phone call conversation once I receive your application. Thanks!
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Email *
Name *
Phone *
Let's start by finding out where you are at. Check all that apply. Be honest with yourself: *
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Check any challenging symptoms that you're currently experiencing: * *
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Are you currently taking any medications or supplements? *
If "yes," please list:
Have you had any major surgeries or accidents? Please list when and what. *
Do you have any medication or food allergies? *
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If "yes" or "maybe," please list your allergies or food sensitivities:
Do you smoke cigarettes or plants? *
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If yes, please list when and dose.
How often do you consume alcohol? *
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Do you experience discomfort in your body? *
If so, where and for how long?
I want.... check all that apply *
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Describe any health breakthroughs you want to experience? Seriously - take a minute and put pen to paper. * *
What 3 things are keeping you from your best self? : * *
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Please list any other reasons, or what would hold you back from investing in your health now. *
Is there anything else you'd like me to know, so I can be of better service to you?
Thanks for sharing. I look forward to our conversation. What is your preferred method of contact to schedule a call if we don't already have one planned? *
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