Christina’s work is deeply personal and highly customized. This application helps us determine whether you’re a fit for her private, concierge-level program ( before scheduling a consultation. Please answer each question honestly and thoroughly.

There are no “right” or “wrong” answers—we simply want to make sure this is the best next step for you.

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Contact Information

Full Name *

Email *

Phone *

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Text HELP to (817) 597-0278 for assistance.

Terms and Conditions

1. What's your current role/title? *

If you choose others, please specify *

2. What best describes your current health situation? (select the closest match) *

I’m functional but struggling with chronic symptoms that are affecting my energy, focus, and quality of life

My health is significantly limiting my ability to work, lead, or show up for my family.

My symptoms have reached a crisis point and I’m worried about long-term or irreversible damage.

I'm high-functioning but operating below my peak capacity, and I refuse to accept this as my new normal

4. What have you already tried to resolve these issues? (select all that apply) *

Conventional doctors / specialists

Functional medicine practitioners

Naturopaths / holistic practitioners

Elimination diets or restrictive eating

Detoxes, supplements, or biohacking

Energy work / spiritual healing

Others

Please explain: (open text field) *

5. What impact is your current health situation having on your life? (select all that apply) *

I can’t perform at my best at work or in my business.

My relationships and family life are suffering.

I feel like I’m losing my edge—physically, mentally, or emotionally.

I’m concerned my health issues could shorten my life if I don’t address them.

I feel like I’m just “surviving” instead of thriving.

6. How many hours each week do you lose to your health? (This includes time spent in pain, too exhausted to function, at medical appointments, or managing symptoms.) *

I lose a few hours a week, but it’s not debilitating.

I lose 5–10 hours a week, and it’s impacting my quality of life.

I lose 10–20 hours a week, and it’s affecting everything I care about.

I lose 20+ hours a week, and I feel like my health is running my life.

7. What would resolving your health challenges mean for your business, career, and family? What becomes possible when you're operating at 100%? *

8. In your ideal world, what would your health and life look like if you could resolve these issues? (Open text field) *

9. On a scale from 1–10, how urgent is it for you to find a solution?

(1 = “it would be nice eventually,” 10 = “I need to fix this NOW before it’s too late”) *

10. If you found a proven process to get to the root cause of your health issues and resolve them for good, how committed are you to following through? *

I’m not really sure—I’m still in the “just researching” stage.

I’m willing to do what it takes if I’m confident it will work

I’m fully committed. My health, energy, and life are non-negotiable priorities right now.

11. How much have you already invested trying to resolve your health challenges?(This includes doctor visits, medications, alternative therapies, supplements, programs, etc.) *

12. What financial resources do you currently have available to invest in your health and reclaim your energy, clarity, and quality of life? (Think available savings, credit, or other immediate resources) *

13. On a monthly basis, what would you be willing and able to invest to resolve your health challenges at the root cause? *

14. Have you ever worked with a high-touch coach or concierge-level practitioner before? *

(If yes: please share your experience in a few sentences)

15. Are you currently under the care of any other practitioners, coaches, or programs? *

16. If accepted, are you willing to make the necessary lifestyle and financial commitments to follow Christina’s program through to completion? *

17. Anything else you want Christina to know about your health, your goals, or why you’re seeking support now? (Open text field) *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business. Contact (817) 597-0278

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