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?
2. Are you aware of any foods that bother you?
3. Are you willing to significantly modify your food choices?
4. Do you have anyone who can support you in your journey?
5. Are you willing to test for additional information need for necessary optimization for YOUR plan?
6. Are you willing to supplement in order to “rehab” your gut health?
7. Are you willing to keep a food journal of everything that you eat?
8. Are you willing to modify your sleep habits?
9. Are you willing to engage in regular exercise? Specific to your needs?
10. Are you confident on your ability to follow through with the needed health related activities?
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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