This inquiry is a space for reflection not perfection. There are no “right” answers. Only honest ones.

Full Name *

Phone Number *

Email *

1. What brings you here at this moment in your life? *

2. What have you already tried to address your symptoms, and how has that gone? *

3. When you don’t feel well or don’t get results, what do you usually assume is happening? *

I assume my body is broken

I assume something deeper is being missed

I assume I need a different strategy

I’m not sure yet

4. Which best reflects what you’re seeking right now? *

A root-cause evaluation and thoughtful plan

Deeper understanding of what my body is communicating

Primarily prescriptions or medication management

I’m still exploring

5. How open are you to addressing factors beyond hormones alone (nervous system, stress physiology, nutrition, relationships, emotional patterns, spiritual health)? *

Scale 1-10 | 1 = Medical / hormones only 10 = Whole-person approach

6. In this season of life, how much time and energy can you realistically devote to your healing? *

I have space and readiness

I have some capacity

I’m currently overwhelmed

7. What does support look like to you right now? *

Clear guidance and accountability

Gentle structure with autonomy

Frequent reassurance and hand-holding

I’m not sure yet

8. I understand Soul of Medicine is a private, out-of-network practice that requires personal investment in care and testing. *

Yes, I understand

I’m unsure and would like clarity

9. Is there anything else you’d like us to know as we consider alignment? *