Apply to Work with Me

Apply to Work With Me!

You’re here for a reason. Something inside you is ready for change, and this is where we begin.

Fill out the form below so I can learn more about where you are now and what you’re working toward. Once you click submit, you'll be automatically directed to a page to book a Complementary 15 minute discovery call.

Name

Phone Number

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Age

What state do you live in? I am currently accepting patients in the state of MD. Patients in other states will be put on a waitlist.

Referred by/How did you hear about me?

What brings you to this call? This call is a chance for us to learn more about you and your goals, and to ensure we’re the right fit for your care. Please briefly share what you’d like to support with -whether it’s hormones, thyroid health, weight management, perimenopause or something else.

Have you worked with a functional medicine provider before?

Yes

What is the main area of your health that you’re hoping to improve or get support with?

What has been the biggest obstacle in hitting your health goals?

So far in your journey, what have you tried to fix these symptoms/complications?

If we could wave a magic wand and help you feel your absolute best this year-physically, mentally, and emotionally- what would that look like for you?

How do you prefer to be supported in your care?

Do you know we operate as a concierge practice (no insurance billing, high-touch care model)?

a. Yes

b. No, I’d like to learn more.

What is your preferred level of communication and access to your provider/coach?

a. Frequent check-ins and direct messaging

b. Weekly updates and calls

c. Monthly check-ins

d. I prefer less frequent communication, only when needed.

Why is it important that you solve these health challenges right now VS. a year from now?

When it comes to making your health a priority, what level of investment feels aligned for you?

a. $500-$2000

b. $2,000-4,000

c. $4,000-6,000

d. $6,000-10,000

e. $10,000+

Is there anyone else (spouse, partner, or parent) involved in your decision-making process? If so, will they be attending the call?

How soon are you looking to start working with me?

a. Immediately

b. Within the next month

c. Within the next three months

d. I’m just exploring options for now

How committed are you to making lifestyle changes to reach your health goals?

a. Fully committed, willing to do whatever it takes

b. Somewhat committed, but need support

c. Looking for guidance, but not sure if I can fully commit yet.

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