Name Email Address What are your current problems at the moment? The more specific you can be the better as it helps me understand what we need to work on together. What would you say is the main thing you'd like to improve? What would you say is the main thing you'd like to improve? Anxiety Mood Swings Insomnia Confidence Self Doubt Irritability Overwhelm Overthinking Brain Fog Loss of concentration Gut Issues Forgetfulness All of the Above Other(s) How often are you experiencing the problems you're facing? Do you know what results you're looking to achieve in the next 90 days? What solutions have you tried in the last 3 years to help cope with these problems? What is the problem(s) holding you back from doing or achieving? Do you promise to have an open mind and an open heart when you show up for our appointment? Do you promise to have an open mind and an open heart when you show up for our appointment? Yes, Absolutely! 7 + 1 = Submit
