Empower Healing
Welcome to the first step to see if joining the Empower Healing program is right for you! Please provide as much detail as possible so I can serve you effectively during our online session. ~Kate C.
What Is your full name? (first and last) *
What is your Primary Goal? *
Just the TOP issue, highest priority to you
What are your Secondary Goals *
Select all that apply
Required
Which of the following do you experience at least on a monthly basis? *
Required
Which of the above ones are most severe and/or most frequent? (several times a week) *
What medications are you currently taking? (Prescription and OTC) *
What, if any, diagnoses or health issue do you have? *
On a scale of 1-10 (10 being the highest), how committed are you about achieving your goals NOW? *
Low
High
Why have you decided to apply for a Strategy Session today? *
What is your current nutrition and exercise routine? *
E.g. Weight Watchers, FODMAPS, AIP, 5:2, P90X, PT... 20 Minute home workout Monday, Wednesday, Thursday with a 1 hour run on the weekend. Nutrition: Breakfast = 2 x eggs, Lunch = Sandwich with ham and cheese + crisps, Snack = chocolate bar, Dinner = Pasta with bacon and cheese, Pre-bed snack = rice cakes
How familiar are you with food sensitivities and inflammation, and their roles in health and weight goals? *
What are your health and fitness goals over the next 90 days (Include current body weight and goal body weight; any symptoms that are bothering you that you would like resolved)? *
HONESTLY, why haven't you reached these goals already? What are your barriers? *
What else have you tried to do to solve this? *
Are you prepared to invest financially to get the results you want and deserve, knowing you have guidance and support from a medical professional and expert in the field? *
What is your email address? *
What is your best contact number (Including International Dial Code) *
What is your time zone? *
Anything else you would like me to know before we talk? *
Thank you! I will be in contact with you soon. I look forward to chatting!! ~Kate
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