Work With Me — Client Application | Confidently Human Wellness

Let's start with you.

Just the basics — I like to know who I'm talking to before we dive in.

First name *

Last name *

Email address *

Phone number

Age range

How did you find me?

Tell me about your health.

I want to understand where your body and energy are right now — no judgment here.

What best describes your current health situation? *

Struggling and frustrated

I've tried things and nothing is working

Stuck at a plateau

I was making progress but hit a wall

Just starting out

I'm ready to make changes but don't know where to begin

Looking to optimize

I'm doing well but want to get to the next level

Which areas are you dealing with? (select all that apply)

Stubborn weight Fatigue / low energy Hormone imbalance Chronic inflammation Stress / anxiety Nervous system dysregulation Poor sleep Gut / digestive issues

Medications or diagnosed conditions?

Interest in peptides or GLP-1 support / education / coaching?

What do you want?

Be specific. The more honest you are here, the better I can show up for you.

Your #1 goal right now *

What have you already tried?

What does success look like 90 days from now?

Which program interests you most?

One last thing — your readiness.

I only work with people who are truly ready. These questions help us both make the right decision.

On a scale of 1–10, how ready are you to make real changes right now?

Not ready at all 100% committed

Investment comfort zone for your health right now?

This isn't about what you can afford — it's about alignment. My programs are an investment in your long-term health and I want to make sure we find the right fit.

What's the biggest thing that might hold you back?

Anything else you want me to know?

Ready to Transform Your Health?

Let's start with you.

Tell me about your health.

What do you want?

One last thing — your readiness.

Application received!