Apply Program — Shadia Akle - Functional Medicine Coach

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THE Happy

 HEALTHY GUT PROGRAM

Full Name *

First Name

Last Name

Email *

IG Handle *

Phone number *

I understand the purpose of this call is to take the next step in working with Shadia Akle Health. I understand this call is NOT to gather free information about an issue I am struggling with. *

Yes

No

What is your main reason for reaching out to Shadia Akle Health? *

On a scale of 1-5, how motivated are you to improve your health? *

What's been the biggest obstacle preventing you from improving your health? *

The Happy Healthy Gut Program is a 4 month program. Are you ready to commit to this? *

Yes

No

Are you currently pregnant or planning on becoming pregnant within the next 4 months? *

Yes

No

I understand I will be placed with a Shadia Akle Health practitioner that best matches my goals and personality. *

Yes

No

What is your current job and how many hours do you work per week (on average)? *

Are you in a good place financially to invest in your health? *

Yes

No

Are you in a good place mentally and emotionally to invest in your health? *

Yes

No

Is there anything else health related that our Client Coordinator should know that was not yet mentioned?

Will you be in a place that allows you to be full present during our call (i.e no distractions)?

Yes

No

Thank you!

**After this form is submitted, you will be prompted to a link which will allow you to schedule a call directly with Shadia.

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