Brain Fog Bootcamp: Thyroid Application

Brain Fog Bootcamp: Thyroid Edition

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Name*

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Email*

Phone*

What state do you live in?

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Have you been diagnosed with hypothyroidism?*

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If yes, have you been diagnosed with Hashimoto's?*

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If you could magically change 3 things about how you currently feel, what would those be?*

What is the biggest thing you hope to achieve in this program?*

Do you have any confirmed medical diagnoses? If so, please list below. (This is confidential! It is really important that I know as much about you as possible!)*

Are you on any medications? If so, please list below.*

What supplements are you taking?*

Are you currently under the care of a medical doctor/provider?*

This is not a weight loss course, but weight changes can (and do) occur as the result of implementing what you'll learn.

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How would you describe your relationship with food currently? What about in the past?*

Do you currently or have you ever had an eating disorder or disordered eating?*

On a scale of 1-5, how motivated are you to make major changes in your diet and lifestyle to achieve your goals? (5 being the most motivated)*

Please enter a number from 1 to 5.

Thank you so much for applying!!!

We'll be in touch really soon 🙂 Looking forward to working together!

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Brain Fog Bootcamp: Thyroid Application

Brain Fog Bootcamp: Thyroid Edition

Thank you so much for applying!!!

What more juicy thyroid deets?