Apply to Work With Me
This takes about five minutes. I read every application myself. If we're a fit, you'll get a link to book a free 15-minute call or move straight to the assessment. If we're not, I'll tell you that too and point you somewhere better.
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Email *
Full name *
Email *
Phone number
Date of birth
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What state will you be physically located in during our visits? *
Where are you with an endometriosis diagnosis? *
Have you had surgery? *
If you've had surgery, roughly when was the most recent one?
Who else is treating you right now? *
Required
Tell me what's going on with your pain. When it happens, what it feels like, what it stops you from doing. *
What have you already tried, and what happened? Surgeries, medications, birth control, diets, supplements, PT, anything. I want to know what failed as much as what helped. *

Four months from now, what would have to be different for you to call addressing your symptoms a success? Be specific. Think about pain, energy, your cycle, sleep, work, sex, exercise, travel, and the things you have stopped doing.

*
What has this already cost you? Not in dollars. In work, relationships, plans you cancelled, things you stopped doing. *
Why now? What made you fill this out today instead of six months ago? *
Which of these is closest to where you are? *
Working with me one-on-one is a multi-thousand-dollar investment in your health. Is that something you're prepared for? *
How did you first come across my work? *
Anything else I should know?
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