I'm Looking For A Few More DREAM Clients...
Here’s What To Do Next
If you know that my Holistic Coaching Program is for you, then please fill out the short application form and I will contact you within 24 - 48 hours to see if you'd be a good fit for my program. If you meet specific client requirements, during our phone call, we will schedule your FREE Health Assessment Session.
Fill Out The Application Below:
MAIN HEALTH CONCERNS
What's the #1 health issue you have?  Be as descriptive as possible, including severity of your symptoms.
How long have you been suffering from these symptoms?
How have you dealt with these concerns in the past?
Have you experienced any success with these approaches?
NUTRITIONAL STATUS
Which of the following foods do you consume regularly? soda, diet soda, refined sugar,alcohol, fast food,gluten (wheat, rye, barley), dairy (milk, cheese, yogurt), coffee
Are you currently on a special diet? autoimmune paleo (AIP), SCD/GAPS, dairy restricted or dairy-free, vegetarian, vegan, paleo, blood type, raw, refined sugar-free, gluten-free, Other (please describe)
 What percentages of your meals are home-cooked?
Is there anything else I should know about your current diet, history or relationship to food?
Other
Please describe any other information you think would be useful in helping to address your health concern(s)
What are your health goals and aspirations?
Contact Information
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Organic MediZen Disclosure Statement:
This website and its contents are for informational purposes only. It is not intended to treat, diagnose, cure, or prevent disease. This report has not been reviewed by the FDA. Always consult with your primary care physician, certified nutritionist or doctor before making any significant changes to your health and wellness routine.