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Apply to work with Jenna

Thank you for taking the time to complete this form. It helps me understand your journey and prepare for our discovery call. I look forward to connecting with you soon and will be in touch to schedule our call once I receive your submission.

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Please fill the following ^*

First Name ^*

Last Name ^*

Email ^*

Phone Number

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What is your occupation? ^*

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How many hours do you work per week? ^*

<25

25-40

40-60

60+

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Please share your main 3 health concerns ^*

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Have you tried anything to improve these concerns? ^*

Yes

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What worked well for you?

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What didn't work well for you?

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Have you worked with any of these practitioners before?

Functional medicine doctor

Dietician/ Nutritionist

Medical practitioner

Chiropractor

Therapist

Health coach

Other

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Please share your experience with any of these practitioners

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How committed are you to addressing your health concerns? (scale 1-10) ^*

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How coachable do you feel you are as it pertains to your health goals? (scale 1-10) ^*

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Do you have a support system in place to help you achieve your goals? ^*

Yes

Maybe

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What do you feel is your biggest challenge when it comes to achieving your health goals? ^*

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How ready are you to invest in your health with professional support? ^*

I'm ready to invest financially and commit fully

I'm willing, but I have some financial limitations

I'm just gathering information for now

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Is there anything else you'd like to share with me?

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Thank you! 🙌

I can’t wait to connect with you soon!

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