Heal Your Gut Program Application Please enable JavaScript in your browser to complete this form.Your Name *FirstLastPreferred Email *What inspired you to apply for this Heal Your Gut program? *Where are you currently at when it comes to your gut and digestive 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 refluxAbdominal painBloatingBlood in stoolBurning sensationsChronic constipationChronic diarrheaFeeling tired after eatingFood allergies/sensitiviesGurgling or burning sensationsHeartburnIndigestionIBSLoose stoolsMucus in stoolSluggish digestionHow long have these digestive concerns been going on for? *Are there any other non-digestion related things regarding your health, challenges or symptoms are you currently facing that you'd love support on? *Do you currently experience any of the following cognitive symptoms:AnxietyBrain fogDepressionFrequent headachesForgetfulnessLow moodMental fatigue/exhaustionMood swingsMigrainesPoor, interrupted sleepPoor memoryOn a scale of 1-10, how committed are you to doing what it takes to create this transformation you seek? *The investment for Heal Your Gut 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? *MessageSubmit
