To confirm... you’re filling this out because you’re ready to get to the root of your symptoms, restore your energy, reduce inflammation, support your hormones, and finally stop feeling like a stranger in your own body? *

First Name *

Phone *

Email *

Date Of Birth *

Instagram Handle *

What symptoms or struggles led you here today?? *

What has this taken from you? What have you tried already? *

How long have you been struggling to achieve these goals? *

What are the top three things you want to change in the next 6 months? *

What makes you interested in working with Electric Alignment specifically? *

Are you ready to make a financial investment into your health? *

We are going to get to know each other pretty well! What are your hobbies, and what do you enjoy doing in your free time? I want to know who you are as a person!!! *

How committed are you to solving this now & achieving permanent results? *

What is your current occupation and how long have you been doing it? *

Work environments have a huge impact on stress. This helps us understand what kind of obstacles we'll be up against.

Do you have a significant other? If so... are they supportive of you potentially investing in your healing, health, and personal growth? *

What would your life look like if these problems were solved? *

If we identified a clear path to help you FINALLY reduce symptoms, restore your energy, calm inflammation, and TRULY address the root causes keeping you stuck... would you be willing and ABLE to invest in the support needed to get there? *

What is it you are looking to gain from having a coach? *

AFTER YOU FINISH, THERE IS A LINK AT THE END THAT WILL GUIDE YOU TO BOOKING YOUR CALL. *

Anything else you'd like to add before booking? *

By you writing “I understand” in the box below, you acknowledge that my time, energy, and expertise are extremely valuable. You are confirming that you will uphold the same level of respect and communication that I extend to you. If I reach out and do not hear back, please understand that we will not move forward together in any capacity. Clear, timely communication is a non-negotiable standard inside my coaching spaces. Please write “I understand” in the box below to confirm that you are fully aligned with these principles. *

My coaching is not casual or surface level! I work with women who are truly ready to rebuild their biology, regulate their nervous system, and create a life that actually feels sustainable. I hold a very high standard for the women inside my containers, because the work we do is deep, intentional, and rooted in real change. If you’re looking for shortcuts, quick fixes, or someone to hand you a plan without asking you to show up for yourself, this is not the space for you. I only accept women who understand that healing requires presence, accountability, and consistency. Women who are willing to slow down, rebuild their foundation, and take responsibility for their patterns. Women who are ready to follow structure, practice nervous system regulation, support their biology daily, and commit to the process even when it feels challenging. Your results are directly connected to the level of readiness you bring into this work. This container is a partnership. I bring precision, depth, emotional intelligence, functional biology, and unwavering support. I expect honesty, effort, communication, and willingness in return. This is not about perfection. This is about a woman who refuses to keep abandoning herself and is ready to do the work required to feel safe, grounded, energized, and in control of her body again. If you are not ready to invest time, energy, and resources into your healing, this will not be a match. But if you feel called to change your life at the root, if you’re tired of surviving, and you know you’re meant for more than the symptoms you’ve been living with, then this may be exactly what you’ve been looking for. Is this you? *

By checking this box, I consent to receive non-marketing text messages from Healing With Avani LLC about appointment confirmations, reminders, and coaching updates. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

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