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Apply TodayWebsite Administrator2023-04-12T11:35:58-05:00

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You Go, Girl!

Way to take the First Step.

Step 3

Fill out Application

After I receive your application, I will reach out on Instagram in the DM to chat!

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Social Media Name or Handle(Required)

What 1-3 goals do you want to achieve in the next 3-6 months, when it comes to weight loss and hormone or thyroid condition (Choose all that apply)(Required)

Lose Weight

Reverse Hypothyroidism or Hashimoto's

Reduce or Get Off Medication

Reverse Other Hormone Imbalance

Reverse Other Auto-Immune Disease

Other (Enter Below)

Other Goal(Required)

What is your main struggle to losing weight right now?(Required)

How much weight would you like to ideally lose?(Required)

At this time, are you willing to make a premium investment in your nutrition goals and a coaching program?(Required)

Yes

No

Do you have any reservations about joining a nutrition coaching program? If so, please list them here!(Required)

Is there anyone else involved in the decision making process of investing in your wellness?(Required)

Priscilla’s coaching is an investment of time & money. Are you prepared to make this investment for reversing your Hypothyroidism or Hashimoto's and meeting your weight loss goals if offered a spot? Check only one.(Required)

Yes

No

Investment ranges vary based on level of support/payment plan chosen (HSA & FSA also accepted). Which monthly payment level(s) would you consider to work with Priscilla? Check all that apply.(Required)

$535-$749

$750-$999

$1000+

If offered a spot, when are you ready to get started?(Required)

Right away!

I'm looking into it

Not now

How did you hear about me?(Required)

Instagram

Google

Referral

Other (Enter Below)

How did you hear about me(Required)

Send Text Messages to:(Required)

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