Extreme Mighty Living:

Wellness Application

Tell Us About You:

Full Name *

Email *

Age *

Where do you live? *

If outside the U.S., please specify your country

How do you prefer to connect for your consultation? *

Video Call (Zoom)

Phone Call

Where did you hear about Mighty Health Mama? *

Your Health & Wellness Goals:

Are you committed to investing in your health & making meaningful changes? *

Yes, I’m fully committed and ready to transform my life!

I’m not sure yet but would like to know more

No, I don’t think I am ready at this time.

What’s your biggest health challenge right now? *

What symptoms or struggles are keeping you from thriving? *

What is your biggest worry? *

What would be different for you if you no longer had these struggles? *

What will happen to your life if you don’t make any changes? *

What steps have you already taken to improve your health? *

What have you tried that has worked for you? *

What have you tried that did not give you the results you hoped for? *

Are you currently working with a healthcare provider who supports a more holistic approach to health? *

Yes

What health professionals or specialists have you worked with so far? *

Your Commitment to Change

True healing requires the right mindset, self-care, patience, consistency, and lifestyle shifts. Where do you currently stand in your readiness for change? *

I’m all in and 100% committed!

I’m open to change but need more guidance on what’s involved.

I want to improve my health but find change overwhelming and difficult.

I prefer a fast and simple solution.

Investment & Readiness

Our Extreme Mighty Living Wellness Program is an exclusive, extremely personalized experience and is not covered by insurance. Your investment is $1395. Are you still committed and want to move forward? *

Yes! I’m ready to take control of my health.

No, I’m not in a position to move forward right now.

Are there any obstacles or hesitations keeping you from taking the next step in your health journey? If so, please share.