new client application

Fill out this form if you’re interested in working with me.

Once submitted, I’ll contact you within two business days.

Name *

First

Last

Email Address *

Phone Number *

Date of Birth *

Gender *

Woman
Man
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What timezone are you in? *

What are your top 3 health goals? *

Tell me about your current health challenges or conditions *

What limitations or challenges are preventing you from addressing those concerns? *

What approaches have you tried that worked for you? *

What approaches have you tried that have NOT worked for you? *

Are you currently on a special diet (i.e. gluten-free, vegetarian, keto, etc)? *

If so, are you open to changing it?

On a scale of 0-10, how committed are you to making the changes needed to your diet and lifestyle in order to reach your health goals?

Selected Value: 0

0= Not committed to making changes 10= Extremely committed to making changes

This type of investigative health work can take several months of working together. How willing are you to invest 6 months or more of your time in this process?

Selected Value: 0

0= Not willing to dedicate that much time 10= Extremely willing to dedicate that much time if that's what it takes

Phone

(828) 367-7742

Email

corie@revelandthrive.com

Location

Asheville, NC

restorative wellness practitioner level one

nutritional therapy association 2022 member in good standing

Disclaimer: The information presented on this website is intended for educational purposes only, and it hasn’t been evaluated by the Food and Drug Administration. This information isn’t intended to diagnose, treat, cure or prevent any condition or disease, nor is it medical advice. One should always consult a qualified medical professional before engaging in any dietary and/or lifestyle change.

new client application

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