GUT HEALTH APPLICATION FORM

If you’re a female struggling to find the root cause of your gut imbalances,

tell us a little about yourself below and follow the links to book a Gut Health Planning Session with our team.

First Name *

Last Name *

Phone *

Email: *

Date of birth *

City *

State *

Occupation *

Hours per week *

What are your health goals right now? *

Gut Health (IBS, bloating, gas, bowels)

Hormone Health (Period pain, missing, heavy ect)

Energy (have more!)

Skin Health (acne, dermatitis, eczema, psoriasis ect)

Heal "diagnosis" (PCOS, endo, thyroid, IBS, autoimmune)

Stress Support (Anxiety, depression, overwhelm)

How important is this goal? *

I want to get started now, make changes & see results!

Its important - but I don't want to start for a couple weeks

I am not sure - I am just looking at different options

It takes a minimum of 6months to make changes to your gut & hormone health - Are you ready to commit to this? *

Yes - I can commit to 6months!

Not at this stage - what are my other options?

To help you understand a little more about The Root Cause Program can you please watch the video above prior to our chat. *

Yes, I can do that!

No, I don’t have the time.

What have you tried so far? *

Nothing, I don't know where to start.

Seen GP, Doctors, standard bloods

Seen naturopaths, nutritionists, made some changes

Done functional testing & protocols

Is your health important enough that you can allocate $400-500 towards testing? *

Yes.

No.

The Root Cause Program is very comprehensive & is a $600 per month investment - Is this in your budget? *

Yes - I want to heal the root cause!

Maybe - I would love to know more!

No - I am not ready just yet

Can I send you email updates? *

Yes

How did you find me? *

Instagram

Workshop

Google

Facebook

Friend

Other

To get the most out of our call, I need you to understand what a Root Cause Approach & Functional Testing is, otherwise I wont be able to adequately help you in the session. If the resources emailed to you are not watched prior to the call, I may need to reschedule your appointment.

Do you have any other questions?

I confirm that I want to receive content from this company using any contact information I provide.