Request for Functional Medicine Coaching with Kayla Howard
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Today's Date *
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Your Full Name *
Your Email *
Your Phone Number *
Your Text Number *
Do you prefer a phone call, text or email? *
I would like more help with: *
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I understand Kayla is not a licensed therapist or medical doctor and I will not receive any medical advice of any kind. I take full responsibility for my health and the wellness of my family. *
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Do you currently use nutritional supplements and/or essential oils? *
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I agree that by submitting this form I am asking for Kayla to contact me by text or email to set up a private consultation. Consultations include personalized programs based on your own unique feedback. We will spend a few minutes chatting via text to determine which type of consultation will be best for you. *
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Please tell me anything you'd like to share that would be helpful in deciding which coaching session would be best for you: *
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