Request Consultation - Living Naturally For Life

Please complete the following.

Thank you for your interest in working with me. Before scheduling your consultation, please take a moment to complete the following, so that I may better assist you.

Name

First

Last

Email

Valid email address required to receive reservation link.

Phone

Textable phone preferable for receiving reminders.

How did you find me? How did you find me?

What issue(s) are you seeking help with?

How committed are you to your health and wellness goals?

I am not deeply committed yet. I am just exploring my options.

I am deeply committed to obtaining my best health.

I am willing to invest in getting the support I need when I find a solution and/or practitioner that resonates with me.

I highly value the opportunity to meet with someone to explore possible next steps to achieve better health.

Check all that apply.

Are you looking to attend appointments virtually or in person?

Virtual

In person

No preference

Are you looking for individual appointments or inclusive programs?

Individual Appointments

Inclusive Programs

Open to both

Do you have a budget or maximum amount you want to spend?

Yes

No

If yes, what is your budget?

Do you have a specific time frame you want to see results?

Yes

No

If yes, what time frame do you expect to see results?

Do you understand naturopathy and integrative holistic health care; that the practitioner may use multiple modalities to assist in achieving whole health; that the practitioner is not a conventional allopathic medical doctor and does not diagnose, treat or cure any disease, but rather seek to uncover underlying causes of symptoms to help clients achieve the best balance possible?

Consent

I understand

Thank you for answering this questionnaire. Please submit to request a consultation. All inquiries are generally answered within one business day. If you have not received a reply in a suitable time frame, please also check your spam or junk folder for reply.

In health,
Michaela Jones, ND