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IMMUNE RESILIENCE

First Name

Last Name

Email *

We do all correspondence by email. Please indicate you are willing to check your email regularly for important information. *

YES

NO

I am open to expanding my understanding of my illness and my symptoms. *

Yes

No

I am willing to commit to 6 months of intensive coaching, attend as many group calls as I can live and book the 1:1's included in the program (within 6 months). *

Yes

No

I am willing to practice Brain Retraining and Meditation Exercises on a regular basis, ideally daily *

Yes

No

I am willing to practice Nervous System Regulation practices Trauma Releasing Exercises on a regular basis *

Yes

No

I am willing to include animal foods in my diet *

Yes

No

I am willing to make changes in my nutrition and lifestyle practices, with my unique sensitivities accounted for *

Yes

No

What is the level of financial investment you are willing or able to make for your recovery? *

Any questions or concerns you have for us? *

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