Empowering Holistic Health 

Question 1

What are your MOST pressing symptoms right now?
(Select up to 3)

• ☐ Anxiety, overwhelm, emotional triggers

• ☐ Trauma, PTSD symptoms, shutdown/freeze

• ☐ Bloating, constipation, digestive discomfort

• ☐ Parasites, candida, gut imbalance

• ☐ Fatigue, brain fog, inflammation

• ☐ Autoimmune symptoms (thyroid, joints, skin)

• ☐ Food reactions or sensitivities

 

Question 2

Which area do you feel MOST needs healing?

• ☐ My nervous system

• ☐ My emotions or stress responses

• ☐ My liver, gut, or detox pathways

• ☐ My immune system or thyroid

• ☐ My hormones and metabolism

 

Question 3

What kind of transformation are you seeking?

• ☐ Emotional stability & inner peace

• ☐ Clearing toxins & repairing digestion

• ☐ Identifying food triggers & calming autoimmune reactions

• ☐ A full-body reset — emotional + physical

 

Question 4

How long are you willing to commit?

• ☐ 8 weeks

• ☐ 12 weeks

• ☐ 16 weeks

• ☐ Whatever it takes — I’m ready

 

Question 5

How severe are your symptoms?

• ☐ Mild

• ☐ Moderate

• ☐ Severe

• ☐ Life-impacting

 

Question 6 — Which describes you best?

(Choose one)

• ☐ “My emotions and stress responses control my life.”

• ☐ “My gut is a mess — bloating, constipation, or parasites.”

• ☐ “I’m inflamed, exhausted, and I think my immune system is struggling.”

• ☐ “All of the above.”