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Personalized Family Health Coaching

This assessment is uniquely designed for families who are dedicated to achieving profound transformations, particularly focusing on their children's developmental progress and needs.

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Question 1 of 16

Welcome! What is your first and last name?

Question 2 of 16

What is the best phone number to reach you?

Question 3 of 16

What time zone are you in, and what days and times are generally best to reach you?

Question 4 of 16

What is the best email address to reach you?

Question 5 of 16

If you're seeking support for your child or children, please share their names and ages.

Question 6 of 16

What is your date of birth, and the date of birth of each child you're seeking support for (if applicable)?

Question 7 of 16

What brings you here today? 

 

Please describe the primary health concerns, symptoms, or challenges you or your loved one(s) are currently experiencing.

Question 8 of 16

Have you or your loved one(s) received any formal medical or developmental diagnoses, or are there any conditions you suspect but have not yet been formally diagnosed? 

 

Please share the details below.

Question 9 of 16

What approaches, treatments, or interventions have you tried so far to address your current health concerns?

 

Please include any dietary changes, supplements, medications, therapies, protocols, or practitioners you've worked with. 

 

Share what you've found helpful, what hasn't worked, or whether you're just beginning your journey.

Question 10 of 16

Have you or your loved one(s) undergone any laboratory testing or other health assessments?

 

If so, please share which tests were completed, approximately when they were performed, and any significant findings or abnormal results.

Question 11 of 16

What does a typical day of eating look like for you and/or your child?

 

Please describe the foods and beverages typically consumed for breakfast, lunch, dinner, and snacks. Include as much detail as possible, including any dietary restrictions, foods you avoid, or differences in eating habits throughout the week.

Question 12 of 16

Do you or your child have any known or suspected food allergies, sensitivities, or intolerances? 

 

If so, please list the foods involved and describe any symptoms or reactions you've noticed.

Question 13 of 16

What improvements or outcomes are most important to you and your family?

 

Please share the specific changes you would most like to see in your or your child's health, development, behavior, or overall quality of life.

Question 14 of 16

What level of investment feels realistic for your family right now?

 

Understanding your budget helps me recommend the most appropriate options, lab testing, supplements, and ongoing support for your family's needs and financial circumstances.

 

Please consider your overall budget for coaching, testing, and supplements when selecting an option below.

 

Sharing your budget helps me prioritize recommendations that are both meaningful and realistic for your family.

A

I'm not in a position to invest financially at this time.

B

Under $1,000

C

$1,000 - $2,500

D

$2,500 - $5,000

E

$5,000-$10,000

F

$10,000+

G

I'm willing and able to invest in whatever my child needs.

Question 15 of 16

Do you have any specific questions, concerns, or topics you'd like to discuss during your complimentary consultation?

Question 16 of 16

Looking ahead to the next six months, what specific improvements or milestones would you most love to see for yourself or your child?

 

What would meaningful progress and success look like to you?

Confirm and Submit