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Digestive Reset Intake + Inquiry

This is where we start with the gut.


The Digestive Reset is a structured process focused on what you eat, how you digest, and how your body eliminates.


Using nutrition, colon hydrotherapy, and reflexology, we work to clear stagnation, support detoxification, and rebuild stronger digestive function from the inside out.


Take a few minutes to share what’s been going on in your body.

I’ll personally review and reach out with your next steps.

Name:

Phone Number:

Email

Preferred way to communicate:

(text / call / email)

What is currently going on in your body or digestion that led you here?

Are you currently experiencing any of the following?

Are you currently experiencing any of the following?
A
B
C
D
E
F
G
H
I

How long have you been experiencing this?

How long have you been experiencing this?
A
B
C

How would you describe your current eating habits?

Do you currently take any supplements or follow a specific diet?

How is your stress level on a daily basis?

How is your stress level on a daily basis?

Is there anything in your life right now that feels overwhelming, heavy, or out of balance?

Have you ever done any of the following?

Have you ever done any of the following?
A
B
C
D
E

What are you hoping to feel or experience after a reset?

On a scale of 1–10, how ready are you to make changes to support your health?

This reset includes guidance around nutrition, lifestyle, and supportive practices.


Are you open to making small daily changes during this process?

Is there anything else you feel is important for me to know before we connect?