Application for Playfully Fierce Healing Program
While the Playfully Fierce Healing Program (PFHP) can target and help numerous health conditions, there are some for which it simply will not be enough. PFHP is a GREAT starting point for nearly everyone, and can be built on for those with more complicated concerns; but Kate wants to make sure it will be an appropriate fit for you so that you will see the benefits! Filling out this application lets her have a better idea if the program is right for you; if you should supplement with additional one-on-one sessions or labs; or if it would be better to be referred on to someone with programs more suited for your needs. She does not want you investing in the program, only to find it wasn't quite appropriate for you at this time, and you end up later thinking 1) Kate failed you, 2) the program failed you, or 3) you failed you. Let's make sure we get you set up on a path with the best possible chance for success and health!
Email address *
Name *
Your answer
Phone Number (Kate will have to call to confirm program acceptance if applicable, welcome you to the group, and walk you through Next Steps) *
Your answer
Best times to reach you? (include your Time Zone) *
Your answer
Which of the following is you PRIMARY goal with the program?
What are your additional health issues or areas of concern that you're hoping to address? *
Your answer
What diet style(s) have you tried in the past? What worked, what didn't? *
Your answer
If you DON'T change your life, what does your future look like in 1, 5, or more years down the road? *
Your answer
If you DO change your life and find relief, what does your future look like in 1, 5, or more years down the road? What do you hope to be doing, feeling, experiencing?
Your answer
How confident are you that you can stick to a Gluten-Free, Dairy-Free personalized elimination plan for at least 30 days? *
not at all confident
100% no problem!
Why did you answer the way you did for the previous question? (what is motivating you; or what are your hesitations, barriers?) *
Your answer
Expectations
The Playfully Fierce Healing Protocol is a commitment; it will require at least one blood test, and strict adherence to not only your personalized food list, but also going Gluten and Dairy free for at least several weeks (taught during the course.) Food sensitivities play a major role in many health problems, but there still can never be a guarantee. And if you deviate from your plan, even a little, it may be enough to stall out progress. Life happens, and Kate understands that, but you need to be ready to give it your all. Since food sensitivities are like addictions, for some, there is a withdrawal period as the body adjusts. We will talk you through them, and you have support, but be sure you realize the commitment you are looking to make. Kate only works with people who are ready to be dedicated and work hard at getting better and feeling their best!
I understand the above expectations, and am ready and eager to talk to Kate and learn more! (type your name) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service