Name * First Name Last Name Email * Age * Current weight and height * Please check any conditions you are currently dealing with Hormonal Imbalances (confirmed through bloodwork) Infertility Irregular Periods (inc. heavy and/or painful) Autoimmune Conditions: Rheumatoid arthritis, Lupus, Hashimotos, PCOS Thyroid Conditions Chronic Fatigue Adrenal Fatigue Type 2 Diabetes or Pre-Diabetes Insulin Resistance (elevated glucose numbers) Brain Health: Memory loss, depression, anxiety Immune system deficiency (always sick) Gut health issues Perimenopause or post menopause Have you eve follwed a ketogenic diet? If yes how was your experience? If you checked any of the above boxes, can you please elaborate more on the condition Have you ever fasted? If yes what was your longest fast and how was your experience? Do you have any vacations or big trips planned over the next two months? Thank you!
