Work with me

Date of birth (required)

Email (required)

Phone number (required)

How did you find Dr. Nadia? (required)

Where are you located? (required)

What program type are you interested in? (required)

3 week group coaching

3 month group coaching

3 month 1 on 1

Individual consultations

What are you looking for help with? (required)

Skin

Hair

Weight

Digestion

Energy

Preconception health

Fertility (trying to conceive)

General Women's Health

Other

Briefly describe your main concern: (required)

How long have you been experiencing these concerns? (required)

<6 months

6-12 months

1-3 years

3+ years

Do you have any diagnosed medical conditions? (required)

Are you currently taking any prescribed medications (not supplements) if yes, please list (required)

In an ideal world, describe what your health will look like 6 months from now (try to get specific, i.e. "I will have regular periods, no more acne, and feel energetic") (required)

What are your expectations for me in our work together? (required)

Your health is an investment and this care is not covered by insurance. Are you willing to make that investment? (required)

Yes

No

Are you vegan? (required)

Yes

No

The most successful outcomes include changes to diet and lifestyle along with other therapies; are you willing to make the necessary changes? (required)

Yes

No

How much time are you willing to commit to making changes? (required)

What are you unwilling to do or unwilling to give up? (required)

If you could eat one thing for the rest of your life, what would it be? (this is just for fun!)

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Application to work with Dr.Nadia

Application to work with Dr.Nadia

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