Want to work together?

Please complete the form below. I look forward to receiving your application and will get back to you shortly!

Name

First Name

Last Name

Why are you interested in working together?

What are you hoping will be the result/results of the work?

What other methods have you tried to address what you're experiencing?

What do you foresee being the biggest challenge/obstacle?

Are you working with any other wellness practitioner(s) right now?

Ex. nutritionist, therapist.

Are you currently taking any medications?

Please list name, dosage and for how long you've been on them.

Is there anything else that you would like me to know?

How did you find me? (optional)

Note: filling out this form is not an automatic entrance to working together. It is used primarily to determine whether or not we will be the right fit.