Kindly fill out this form to join Lori Bouchard's wait list. We will reach out as soon as possible with next steps. We look forward to supporting you!

Disclaimer:
Lori Bouchard is a highly sought-after Naturopathic Doctor licensed in Ontario, Canada. While she serves as a Metabolic Health Consultant for those outside the province, her expertise in cancer care is unparalleled. Due to her commitment to providing exceptional, personalized care, Lori only accepts a limited number of clients each month. If you’re ready to explore transformative retreats and advanced healing services for all stages and types of cancer, apply now and we will contact you as spots become available.

Full Name *

Date of birth *

Address *

Email Address *

Phone *

First, tell us a bit about yourself. Where do you live, what do you do, whether you have partner or kids, etc. (A few sentences or bullet points please.) *

What is your diagnosis and when were you first diagnosed? What's going on now? *

What is your biggest cancer related struggle right now? *

How did you first hear about Lori Bouchard's approach to healing ? What made you interested in applying? *

On a scale from 1-5 (5 being the highest) how ready are you to make a change to your lifestyle (eating, exercise) in order to reach your goals? *

Why is now the right time to invest in yourself and take action? Why not six months ago or six months from now? *

Anything else you would like to add?

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