Thyroid Clarity Call Intake

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This short questionnaire will help me get a better idea of your health symptoms so that I can better support you. Once you complete the form I’ll be in touch to set up our 30 min Thyroid Clarity call.

Name *

E-mail address *

Which thyroid condition have you been diagnosed with? *

Hypothyroidism

Hashimoto's thyroiditis

Hypothyroidism + Hashimoto's

Haven't been diagnosed with either but I suspect I have a thyroid condition

What are the top 3 symptoms you're currently struggling with? *

What type of support are you looking for? i.e. education, nutrition, meal plans, clarity, accountability, guidance *

What do you believe to be true about your thyroid condition? *

Is there anything you're not willing to do or that would stand in the way of you getting incredible results? Be honest!

Are you able to make a financial invest into a health program at this time (payment plans available)? *

Yes, I'm ready to do what it takes to feel better!

I'd like to make changes but I'm not able to commit financially

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