Hello Lovely!

Before we chat, I’ll need some more info from you. In order to get the most out of your Breakthrough Session, please fill out this form to the best of your ability. This information will help me to get to know you, what areas you are struggling with and how I can help you. 

This call is reserved for women who are ready to commit and take action to change their life and their habits to finally live the life they dream of!





How often do you check your email?
DailyWeeklyMonthly















Do you sleep well?
YesNo

How often do you wake up in the middle of the night?
OftenSometimesRarelyNever


Do you struggle with any of the following?
ConstipationDiarrheaGasBloatingDistention




On a scale of 1 to 10 how would you rate your general energy level? (1=lowest)




What foods did you eat/drink as a child?





What foods do you eat/drink as an adult?








Do you believe you can overcome your current health issues?
YesNo