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.
start
 
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 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? *

 
How did you hear about Enlightened Wellness? *

Thanks for completing this typeform
Now create your own — it's free, easy & beautiful
Create a <strong>typeform</strong>
Powered by Typeform