Application for Coaching

First Name *

Last Name *

Phone *

Email *

Instagram Handle *

Who were you referred by? We'd love to say thank you!

How long have you been struggling with these symptoms? *

<6 months

1 year

1-2 years

2+ years

On a scale of 1-10, how important is it to you to fix the problems listed above? *

0-2

2-4

6-8

8-10

What are the biggest hurdles you’ve been trying to overcome on your own? *

Tell me about your goals! What is your ultimate goal 4-6 months from now? What do you want to be doing? How do you want to feel? *

When are you hoping to get started or implement a solution? *

Do you and your significant other make financial decisions together? Do they know you are booking this call and are supportive of a decision that you will make? Please talk to your partner about your budget you have chosen BEFORE the call OR have them join us on this call. This way if we align together we can get you onboarded during this call. *

Yes

Are you ready and willing to invest time and financial resources for 1-on-1 support in solving your TMJD? Our self-guided and high touch accountability programs range from $197-$4,999 for 4-12 month programs depending on what someone may need for full healing. (FYI: We DO accept HSA payments, but we are not in network with insurance.) *

YES I am ready and willing to invest both time and financial resources into my health and I have my partners support if this program aligns with me.

MAYBE I actually am very ready to solve these concerns, but may need to come up with a financial payment plan to make this work for me.

NO, I am not ready to invest financially or my time into this even if that means I have to wait and figure it out on my own.

Are you looking for in person or virtual? *

In Person

Virtual

Anything else you'd like to add before booking? *

Step 1: Fill out the Contact From Below

Testimonials