The Hormone Balance Solution Application Form
Thanks so much for applying to work with me, I’m excited to see if we’re a good fit to work together! We need to ensure we are both on the same page so you don’t waste your time or money and I don’t waste my time.

The only way I work with women is in a committed working relationship. This means, I’m committed to you and I will do everything in my power to help you overcome your current health struggles. Likewise, you are committed to the process and what needs to be done in order for us to give it our best shot at getting you your desired outcome. This involves you trusting me and my education and clinical experience that has allowed me to determine the best way to work with clients in order to see results.

You also have to be both financially and emotionally ready to invest in your health. There are no quick fixes and there is a financial investment involved on your behalf.

I'm excited you've made it to this application form and hopefully we'll get the chance to work together to get you moving in the right direction for your health.

Tara
Sign in to Google to save your progress. Learn more
Email *
Name
Age
Country of Residence
Please answer the following questions and I will review your responses & be in touch to suggest how I may be able to help you.
Are you currently in menopause? *
Are you currently pregnant or breastfeeding? *
What are your major health complaints right now that you'd like help with inside The Hormone Balance Solution? *
Do you have any medical diagnosis? If so, what are they? *
Are you currently on any medications? If so, which ones? *
What have you previously tried in order to get on top of your health symptoms? (Diet? Lifestyle changes? Doctors? NDs? Supplements?). *
What is your commitment level when it comes to making changes for your health, on a scale of 1 to 10 with 10 being absolutely committed and ready to do whatever it takes? *
Absolutely Committed and Ready!
Do you follow a vegan or vegetarian diet? If yes, are you willing to add in some animal protein? *
How much do you think you've already spent on trying to find answers to your health symptoms? *
Are you ready to make a financial commitment in your health between the range of $2,000 and $3,000 USD? *
How did you hear about me?
Clear selection
Thank you
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy