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The Root Cause Clinic Application Form
First & Last Name
Email
State or Province
Please share a bit about your current health struggles:
How would your life change if you were able to overcome these struggles?
What have you been struggling with on your own to achieve this goal? How long have you been struggling with this?
Your current employment status
*
Full time
Part time
Student
Stay at home mom
Unemployed
What do you do for work?
On a scale of 1-10, with 1 being I am content with my current health and 10 being I need to make a change now, where do you fall?
If it's a good fit on both sides, are you ready to start right away? If you are not ready please wait to schedule a time when you are!
If we're able to find a way to achieve your desired goals by working with us, would you be willing (and able) to invest in getting the help necessary to get there?
Choose an option
We believe in an all encompassing approach as holistic health practitioners. This includes bioenergetic scans, energy work, nutrition, supplements and detox support. Does that work for you?
Choose an option
You will be asked to book a discovery call on the next page. I look forward to speaking with you and potentially helping you reach your health goals! Is there anything else you would like me to know?
Submit Application
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