ReRoot & Recharge Strategy Session Application

Please complete this brief application to help determine your eligibility. If selected you will receive a response within 3 business days.

Name(required)

Email(required)

Phone(required)

Age(required)

Are you able to be available M, T, Thu between 9AM- 4PM and 6PM-7PM EST for appointments?

Briefly describe your current symptoms.

What have you already tried to resolve these problems?(required)

How are these issues holding you back from your life, career and aspirations?(required)

Why is now the right time for you to address these issues?(required)

Do you think friends and family will be supportive of you making changes to improve your diet, lifestyle and weight?(required)

Nicky, if I am selected and decide to work with you, I’ll find a way to invest in myself and my future:(required) I have the necessary means to invest in my health and future

I have the ability to get the necessary means to invest in my health and future

I have no financial means to invest in my health and future