First Name
Last Name
Email
*
Phone
*
What country do you live in?
What are you looking for more info about?
1:1 Coaching
Histamine Relief Roadmap
Revive with Heather Community
Lab Review
Ordering Labs
What type of Practitioners have you worked with so far?
Only regular doctors
Acupuncturist
Herbalist
Holistic/Naturopath (not functional or MD)
MD with Functional Medicine Training
Functional Medicine Practitioner (FMP)
Geneticist
Other
Have you had functional medicine testing? If so, which tests?
GI Map/Gut Zoomer/ Other Stool Test
Hormone Testing (Blood or DUTCH)
Genetic Testing
Methylation Panel
HTMA/Mineral/Nutrient Test
Mold/Mycotoxin
Others
On a 1-10, 1 being less and 10 being more - how are your histamine issues affecting your quality of life?
1
2
3
4
5
6
7
8
9
10
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Working with us is an out of pocket expense not covered by insurance. We have different levels of support with the minimum being $1500. Are you ready to invest at this time?
Yes, I am tired of feeling this way!
No, not right now.
Tell me in as much detail why you are seeking help from me now?
Does your spouse/partner/parent support you on this journey?
Yes
No
N/A
Are you truly ready to make lifestyle changes to see progress? (minor AND major)
Yes! I am ready!
Maybe - I have struggled in the past
No, I don't really want to put in the work
When are you looking to get started?
ASAP
In a few months
SUBMIT
