This short questionnaire helps our team understand your goals, symptoms, and health history so we can strategize the best way to support you.

Please answer each question to the best of your ability to qualify for the next step.

⏱ Takes about 2 minutes

What's your first and last name? *

At Vital Spark, we've helped over 3,000 women heal their metabolism, balance their hormones, and improve their gut health to finally lose weight by addressing the root cause using our Functional Fat Loss System.

This is a 1:1 program where you work with a functional health practitioner. Does having that level of support and investment sound like what you're looking for? *

Yes - This is exactly what I've been needing

Maybe - I'm curious, but not totally sure yet

No - This isn't what I'm looking for right now

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

Work environments have a huge impact on stress, and therefore weight loss. This helps us understand what kind of obstacles we’ll be up against

Right now, I'd describe myself as... *

I'm really struggling — I feel inflamed, exhausted, and really uncomfortable in my body. My bloating, fatigue, and mood changes are really affecting my day-to-day. I know something is off in my body and I’m ready for a full reset.

I'm starting to not feel like myself — I’ve gained weight and don't feel as energized as I used to, and I'm starting to suspect my hormones and/or gut health are off.

I'm doing okay with my health & fitness, but I’m not making as much progress as I would like to — I know I could lose some weight and feel better day-to-day if I targeted my hormone & gut health more.

I’m in decent shape, but I want to optimize my health and learn from experts — I want to make sure my hormone health, gut health, and metabolism are in peak condition for the long run. 4

When was the last time you truly felt great in your body — confident, energized, and in control of your health? *

Within the last year

2-5 years ago

Over 10 years ago

Honestly, I've never really felt that way

12 months from now, I want to... *

Feel confident and strong in my body — like I’m in the best shape of my life and can wear a swimsuit without picking myself apart.

Have my hormones fully in balance — zero PMS, bloating, cramping, mood changes, or hormonal weight gain.

Experience optimized gut health — no more GI issues like stomach pain, bloating, gas, irregular bowel movements, or food sensitivities.

Feel better mentally — less stress, more clarity, healthy relationship with food, and living with freedom from anxiety or burnout.

Honestly? All of the above

On a scale of 1–5, how ready are you to make real changes to your health right now? *

1 – I could put this off for a while

2 – Curious, but not quite ready

3 – I want to make a change soon

4 – I’m ready and just need the right support

5 – I’m all in — I need this now

Which country / region do you live in? *Time zones are important to plan for so that we can support you as best as possible.

If this program feels like the right fit, how would the decision to move forward happen? *

I make my own health decisions.

My partner trusts me to make decisions like this.

I'd want to discuss it with my partner first.

My partner would need to be part of the decision.

If you determine this program is the right fit for you to achieve your goals - are you in a position to invest time, energy & finances toward improving your health? *

Yes. I'm ready to invest and solve my health problems.

I'm open to it, but may need some support or options.

Now isn't a good time, my cash flow is month to month and I have no access to credit.

I'm mostly researching, but not quite ready to commit.

Note: our programs are individualized so we can't say exactly how much of an investment it will be until we talk and see what YOU need... functional lab testing alone starts at around $500, and we currently do not offer lab testing alone without also investing into a coaching program.

What is your email address? *

So we can hook you up with some free resources after our strategy session

What is your phone number? *

Please confirm your mobile number [It's really important this is correct so that we can confirm your application + help you book your free strategy session]

Please add your Instagram handle and/or Facebook name for us to connect with you! *

How did you hear about us?

Click "SUBMIT" below to submit your application and be redirected to a calendar to book your free Consultation Call with one of our Metabolism & Hormone Advisors! If for some reason your application is not approved, we’ll reach out directly to let you know. Thank you!