Skip to content
Integrative Health Practitioner | Functional Medicine | Mindset & Wellbeing Coach
Privacy
Terms
Integrative Health Coaching Application Form
Integrative Health Coaching Program Application
Please enable JavaScript in your browser to complete this form.
Your Name
*
First
Last
Preferred Email
*
What inspired you to apply to become a client of Bindi's with this Integrative Health Coaching program?
*
Where are you currently at when it comes to your health? What challenges or symptoms are you currently facing that you'd love support on?
*
When it comes to digestion and gut health, do you regularly experience any of the following:
Acid reflux
Abdominal pain
Bloating
Blood in stool
Burning sensations
Chronic constipation
Chronic diarrhea
Feeling tired after eating
Food allergies/sensitivies
Gurgling or burning sensations
Heartburn
Indigestion
IBS
Loose stools
Mucus in stool
Sluggish digestion
How long have these digestive concerns been going on for?
*
Are there any other cognitive or mental health challenges or symptoms are you currently facing that you'd love support on?
*
Do you currently experience any of the following cognitive symptoms:
Anxiety
Brain fog
Depression
Frequent headaches
Forgetfulness
Low mood
Mental fatigue/exhaustion
Mood swings
Migraines
Poor, interrupted sleep
Poor memory
On a scale of 1-10, how committed are you to doing what it takes to create this transformation you seek?
*
The investment for Integrative Health Coaching with Bindi is $500 USD / month with a minimum 4-month commitment. Are you willing to invest in yourself to create this transformation for yourself?
*
Yes, I’m willing and able to invest in myself with this.
I’m willing to get resourceful to make it happen 🙂
I’m not able to pay this right now.
Is there anything else you'd like me to know about you, your health history or your circumstances? Do you have any questions or concerns you'd like to share with me considering working together?
*
Email
Submit
Home
About
Work With Me
Meditations
Podcast
Podcast
Ask Bindi
Labs
Shop
Contact