Before we hop on a call, please answer these questions so I can understand your symptoms, your goals, and how to best direct and support you on your call.

First Name *

Last Name *

Email *

What is your instagram handle? (if you don't have Ig, please name social media site, you found this on) *

Where are you located (city, state, country)? *

Anything you'd like to add about these symptoms? (Short answer)

When did these symptoms begin? *

Within the past 3 months

6–12 months ago

1–3 years ago

3+ years ago

Was there a specific event or moment that triggered things? (Short answer) *

Have you tried to improve these symptoms before? (Check all that apply) *

Dietary changes (gluten-free, low carb, elimination, etc.)

Probiotics or supplements

Medications (laxatives, antacids, PPIs, antibiotics, etc.)

Stress-management techniques

Lifestyle changes (more sleep, exercise, removing trigger foods)

Worked with a practitioner

Other

I haven't tried anything yet

If you HAVE tried things, why do you feel they didn’t work long-term? (Check all that apply) *

I didn’t have guidance or a clear plan

I struggled to stay consistent

I didn’t see results quickly

I was overwhelmed or confused on what to do

I didn’t address the root cause

I wasn’t sure what to try next

Other

What would success look like for you 3 months from now? (short answer) *

How would you describe your current diet? *

Very healthy (whole foods, balanced meals)

Somewhat healthy (occasional processed foods)

Unhealthy (frequent processed foods, sugar, etc.)

I’m not sure

How many servings of vegetables do you eat per day? *

None

1–2 servings

3–4 servings

5+ servings

Do you tolerate vegetables well? *

Yes

Sometimes

How many hours of quality sleep do you get each night? *

Less than 4 hours

4–5 hours

6–7 hours

8+ hours

Have you been on hormonal birth control or other long-term medications? *

Yes

Have you had any labs run in the last 2–3 years? *

Yes

If you have had labs run, which ones?

What do you feel is the biggest thing holding you back right now? *

Have you ever invested in coaching or a health program before? *

Yes

If you feel I can help you create a plan that transforms your gut health… are you ready to make an investment in yourself? *

Yes

I think so, but I have questions

Maybe — depends on cost

Not yet

What are you hoping to get out of this call? *

Is there anything else you want me to know before we meet? (short answer) *

Thank you — I’ll review your answers before our call so you can get the most clarity and direction from our time together.