Brain Fog Bootcamp: Thyroid Edition Please complete the form below to be considered for Brain Fog Bootcamp: Thyroid Name* First Last Email* Phone*Which format of BFB: Thyroid are you interested in joining?Small Group Coaching onlySmall Group + Lab Add onSelect oneIf you chose the "Add On Lab" option, do you live in the United States?YesNo(Labs are only available to those in the United States.)What state do you live in? Type inHave you been diagnosed with hypothyroidism?*YesNoSelect oneIf yes, have you been diagnosed with Hashimoto's?*Yep, that's me!No, I do not have Hashi'sUmm... what?Select oneBFB: Thyroid is not designed for HYPER-thyroid nor Grave's disease.Okay! I understand.Shoot, I have hyperthyroid and/or Grave'sSelect oneIf 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.Aw, shucks. Really just want weight loss.Totally fine. Weight changes would be great, but not main goal.Not concerned at all. Just want my brain back.Select oneHow 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.This program is not a passive experience, but don't worry, I won't call on you to answer or openly talk in group calls if you'd prefer not to. That said, to get the most out of your experience, I do suggest (and encourage) participation in the group forum (asking questions, offering advice, sharing successes, etc.). Sound good?*Thank you so much for applying!!!We'll be in touch really soon 🙂 Looking forward to working together! PhoneThis field is for validation purposes and should be left unchanged.
