Healthy Autoimmune Pregnancy Protocol Application
**PLEASE READ THIS FIRST**

Hey Future Mama!

We're so glad you decided to apply for our Signature 12 month Healthy Autoimmune Pregnancy Protocol and we can't wait to support you throughout your pregnancy, birth, and postpartum.

*Please fill this out completely and honestly WITH YOUR PARTNER. There are no wrong answers! ​

Why an application? We are looking to broaden our community with future Mamas who are COMMITTED to pursuing positive change for THEIR FUTURE BABY & THEMSELVES. Our Signature Healthy Autoimmune Pregnancy Protocol is a transformative program with a high-level investment, therefore we want to make sure that all mamas who are invited to enroll are a good fit.

Why with your partner (if applicable)? We KNOW that both partners MUST be involved every step of the way for the maximum transformation! 'It takes a village' - and it starts with you BOTH.

*ONLY fill out this application if you are willing to invest in your health and your baby's health throughout pregnancy, birth, and postpartum.

We understand that start times for 1:1 coaching may vary from Mama to Mama, however we see the most success with individualized goals when we work with our clients throughout pregnancy, up to ~3 months postpartum.

After you and your partner submit your application, you will be asked to choose a time to connect over the phone (THAT BOTH YOU AND YOUR PARTNER ARE PRESENT FOR). Choose a time that is 48+ hours from now so we are able to prepare accordingly.

*If during our call, we decide as a group that you are a good fit, you will then be invited to join our individualized 1:1 coaching program.


Email address *
Name & Partner's Name (if applicable) *
Phone Number: *
Are you applying while... *
Mama: Tell us about yourself and your current pregnancy reality (number one goals, health fears, unrelated health fears, major stressors, your current struggles, etc). We want to hear it all! *
Partner: What are your thoughts about your partner's pregnancy (Fears, wishes, stressors, aspects you see from your perspective and wish to share, etc.)? How involved are you in helping your partner achieve her ('your' - as a couple) pregnancy goals? We want to hear from YOU!
Mama: What is your #1 health goal you would like to accomplish in the next 12 months? What is your DESIRED situation? (health, prep for birthing and breastfeeding, lifestyle, stress management?) *
Mama: Be Honest - what do you think is stopping you from reaching this goal on your own? (The more specific you are the more we can help you!) *
Mama: What do you believe makes us a good fit to work together in The Healthy Autoimmune Pregnancy Protocol? *
Partner: What do you believe makes us a good fit to work with your Mama-to-be in The Healthy Autoimmune Pregnancy Protocol?
Mama: Have you ever invested in an autoimmune related coaching program before? What was your experience? *
The Healthy Autoimmune Pregnancy Protocol is a high-level investment. If you are looking for the cheapest option, this is not for you. If you are looking for high-touch, 1:1 support that you won't be able to find anywhere else, then we are ready for you! *
By filling out this application, I commit to showing up to my designated call time (decided upon application submission). *
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