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Pregnancy & the Body
Transform Your Life
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Home
Pregnancy & the Body
Transform Your Life
Blog
Gut Check Program Application
Application for Gut Check Program
Application for Nutritional Rehab Program: How to optimize you gut health
Here are a few questions we need to discuss before we move forward.
Name
*
First
Last
Email Address
*
Phone Number
1. Have you tried eliminating any foods already?
Yes
No
2. Are you aware of any foods that bother you?
Yes
No
3. Are you willing to significantly modify your food choices?
Yes
No
4. Do you have anyone who can support you in your journey?
Yes
No
5. Are you willing to test for additional information need for necessary optimization for YOUR plan?
Yes
No
6. Are you willing to supplement in order to “rehab” your gut health?
Yes
No
7. Are you willing to keep a food journal of everything that you eat?
Yes
No
8. Are you willing to modify your sleep habits?
Yes
No
9. Are you willing to engage in regular exercise? Specific to your needs?
Yes
No
10. Are you confident on your ability to follow through with the needed health related activities?
Yes
No
Please type your answer below:
Describe what motivates you to make a change
1. What do you hope to achieve with this program?
2. Did something trigger your health to change?
3. What do you think is happening and why?
4. What do you feel needs to happen for you to get better?
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Email
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