Vessel and Soul Client application

Tell me a little about yourself. I'll reach out as soon as possible to schedule a time for us to meet.

Name *
Name
Primary health concerns *
Let me know where you're at; what concerns, symptoms, diagnoses do you experience?
Please identify any family history of diabetes, autoimmunity, cancer, cardiovascular disease, cancer, mood disorders, alcoholism, etc. Please list relationship as well.
What currently is causing the most stress? job, relationship, appearance, health, financial,...
How many times per day on average do you go poo? No shame here, I can talk poop allll day ;)
What does your breakfast food and beverage typically look like? Options welcome
What does your typical lunch food/beverage look like? Options welcome
What does your dinner food/beverage typically look like? Options welcome
What kinds of snacks and desserts do you typically consume? How often?
ex: 'I sleep from 10pm-6am, difficulty falling asleep, restless, groggy upon waking'...
Feeling better, family, health, love, job, money, happiness, friends, my kids, spirituality, more energy, ...
What's your phone number and/or Skype username? Anything else you'd like to add?