Thank you for taking the time to apply to be  an Enlightened Wellness client. You will be contacted within 24-48 business hours of submitting your application.
Please provide your first and last name: *

What is the best email address for contacting you about scheduling? *

What is the phone number, with area code, where you can be reached, should we schedule a Clarity Call? *

What is your time zone? *

What are the top 3 health or life problems that you are looking to resolve? *

How have you dealt with these in the past? *

What do you feel is holding you back from having the health and life that you want? *

What do you think may be needed to resolve your health and/or life issues? Think about this. Feel into it. You have more answers than you realize, and I can help you tap into that. For now, give it your best shot. *

How important do you feel it is to address emotional issues and cultivate mindfulness as a part of your healing journey? *

Please tell me your thoughts on engaging in a therapeutic, collaborative partnership with someone like me, versus just being told what to do. How do you feel about this?  Please be honest and explicit. *

How is your relationship with your body at this time? Do you feel you can trust your body, or do you feel betrayed and confused by it's symptoms and messaging? *

On a scale of 1 to 10, with 10 being the most ready, how ready are you to find your nutrition, lifestyle, mindset and other root causes and address them in the context of a therapeutic, collaborative partnership with a Functional practitioner? *

If this turns out to be the best decision you ever made, how will your life and health (if you are also facing health challenges and are interested in functional nutrition) change during our time together? *

Please provide your initials in agreement with the following statement: 
I understand that one on one coaching and functional nutrition is an investment in myself, my health/work/business, and my life.  I am ready to make that investment if the fit is right. *

How did you hear about Angie/Enlightened Wellness? *

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