Financial Hardship

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* 1. What is your name?

First

Last

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* 2. Please enter your best email

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* 3. How much would you be able/willing to pay for Holistic Health Coaching, Lifestyle and Nutrition Guidance while still being able to take care of yourself?

0-50$ a week

50-100$ a month

100 -200$ a month

Please type a different amount or None

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* 4. Would you mind sharing what contributed to this financial hardship?

COVID

Lost job

Freelance Worker

Injury

Illness

Prefer not to answer

Other (please specify)

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* 5. What is your current financial situation?

Living off Unemployment

Living off Savings

Have settlement payments

Sporadic Freelancing gigs

If Other, Please Specify

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* 6. The Nutrition Steward is committed to serving individuals who are dedicated to their health, open to receiving support on an individual level and learning to listen and uncover their body's unique needs.

If you received services at a discounted rate due to your current financial situation, would you promise to commit yourself in order to support your own health?

In two or three sentences, tell me something about yourself and/or your health history that will help me get to know you before we take any further steps to dig more deeply into the details of your concerns.