Your Healthiest Self: Application Form
8 week online program that incorporates nutrition, mindfulness, hormone balancing, and physical activity to help you transform into your healthiest self, and have the tools to maintain that health for life.
Taught by Dr. Rehan Lakhani, ND, Victoria Galletta, Registered Kinesiologist, and Dr. Liz Dalglish, ND.
Watch this video to learn all about the program!
Full name (first, last)
Which area(s) of health do you currently need help in?
Chronic disease management
Congratulations on making a huge decision for yourself and your health!
Typically this type of program would have a cost associated with it to compensate the practitioners for their time, however, in light of COVID-19, we've decided to donate our time to help as many people as we can. It's our goal to support and strengthen the physical, mental and emotional health of all who will be participating.
In lieu of service fees, we ask you to consider making a donation to the Collingwood General and Marine Hospital to strengthen their efforts in treating COVID-19.
If you would like to donate, please select the "Yes" option below, along with the amount that you would like to donate. We will send you an invoice that reflects the amount that you can pay online via e-transfer or credit card.
Thank you and once again, congratulations! Our team is excited to get started with you!
Would you like to donate to the Collingwood General and Marine Hospital in lieu of service fees for this program?
What amount would you like to donate?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service