Let’s get started! Once we've decided to work together, please take the time to fill out the following intake form. I look forward to supporting you on your health journey!

Name

First Name

Last Name

Email Address

Diet *

Please submit a 3-4 day diet diary. I want to get an idea of what your daily routine looks like (there are no wrong answers here!) Please list food allergies, sensitivities & aversions.

Mind *

How do you care for your mind? Your thoughts? Do you seek the support of a therapist or spiritual counselor or have you done so in the past?

Body *

Tell me a bit about the current state of your body and health. Energy & Happiness levels? How do you care for your body (daily, weekly, monthly) Do you exercise? If so, what activities do you enjoy?

Spirit *

In what ways do you care for your spirit? Do you have a Spiritual Practice? How much time do you spend in nature? Do you have a meditation practice of any kind?

Lifestyle

What's your life like? What do you do for fun? What are your interests? (Activities & hobbies) Tell me a bit about your daily/weekly/monthly rituals surrounding self-care + wellness practices like exercise. Are you working with any health practitioners? (acupuncturist, massage therapist etc)

Supplements

Please list any vitamins, probiotics, herbs, superfoods, supplements, medications, or over-the-counters you are taking.

Goals

List your top 3 health goals and anything that you feel is standing in the way of your progress.