Fill out the form below. Let’s connect!

What is your name?

First Name

Last Name

Email Address:

Phone Number:

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What is your favourite area of your life? The pastime you would choose the MOST ?

You LOVE: working out, sleeping, focusing on your job, watching tv, internet scrolling, talking to your loved ones, etc.?

What area of your life do you totally avoid until the last minute?

Avoiding this is LIKELY: exercising, cleaning, talking to others, reading, paying bills, eating, sleep?

Do you notice certain foods affect your mood? Or foods that affect your stomach? Do you focus on eating a certain way?

Are there any food values important to you such as weight-loss, daily requirements, sport performance, food allergies?

Any prior or medical conditions, diseases, medications? Please list ANY and ALL

Do you use any supplements, teas, products?

For an Intro Appointment, let's VIRTUALLY connect over Zoom, Google Meet-Ups or a great Phone Call! When are you free?