Welcome!

Let's find out if the JOURNEY TO WELLNESS PROGRAM is the right fit for you.

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We are looking for people who are ready to do the deep work to finally create health freedom and find the answers to the health problems other doctors couldn't solve. If we decide to work with one another, we will challenge you to stay committed to your transformation in the same way that we will be committed to your growth.

In this application, we will be asking you several questions. Please take your time completing this application. Once submitted, you will schedule a call on our calendar.

First Name *

Last Name *

Phone *

Date of birth *

What are your top three health concerns? *

What type of holistic medicine and/or functional medicine care have you tried in the past? *

On a scale of 1-10, how committed are you to do what is necessary to get and find results? *

Are you prepared to invest in out of pocket health services in order to find your root cause answers? *

Yes, absolutely.

Not right now.

Lastly, is there anything else that you would like to share? (make sure to book your call on the next page) *

You're all finished! (The last thing we need is the email you used to register with so we can keep everything connected to your account) *