4 Week Gut Protocol Intake Form
4 Weeks dedicated to your gut health. This isn’t about weight loss. This isn’t about workouts (although both are a possibility ). It’s about showing YOURSELF how the food you eat impacts your gut health and overall health. Unaddressed digestive issues can mess with your immune system, energy levels, even your mood! This 4 week program was designed by an expert team of nutritionists and PhDs to make it easy to follow so you can finally stop guessing and start feeling like your best, healthiest self again!Free option: Pair it with 4 Weeks for Every Body, a no-impact fitness program, and our recommended supplements, and go all-in on truly feeling your best. Studies show that moderate exercise can have a positive impact on digestive health. That’s why we have added a no-impact 4-day-a-week fitness program that takes the stress off your joints, so your body can do the work it needs to support your gut. Using just dumbbells and a Core Ball, 4 Weeks For Every Body is designed to work for every fitness level. It’s simple enough for beginners, and challenging enough for even advanced users to feel the burn. Workouts are 30 minutes or less, making it easy to maintain consistency while you build overall strength and mobility.
Registration Form
Please fill in the form below.
Full Name
*
Prefix
First Name
Last Name
Do you have any of these symptoms
*
Diahrea
Gas
Bloating
Skin Conditions
Lack of energy
Long-Haulers (post COVID) symptoms
Other
How did you find me
*
Facebook
Instagram
Friend (please type their name in "other")
We're friends silly!
Other
Have you ever done a food elimination diet before?
*
Yes
No
Not sure
Other
Do you have any health concerns or physical limitations that I should be aware of?
*
Let's Talk Nutrition
Do you have any food allergies or intolerances that you know of?
*
Current struggles with nutrition (check all that apply)
*
Cravings
Accountability
Portion control
Commitment
Self-Discipline
Time
Money
Not eating enough veggies
Low energy
Other
Let's talk current fitness
How would you describe your current physical activity level?
*
Sedentary (No Physical Activity)
Somewhat Active (Less than 150 minutes of moderate activity a week)
Active (At least 150 minutes of moderate activity a week)
Very Active (150 minutes or more of vigorous activity a week)
How much time a day are you willing to devote to exercising?
*
Describe in minutes
How many days a week?
*
Do you have any exercise equipment at home or do you have a gym membership?
*
Please describe the type of equipment you have available to you at home or at the gym.
Mindset
How willing are you to commit?
Are you ready for a change?
*
Yes
No
What has stood in your way from reaching your goals in the past?
*
When are you ready to get started on this lifestyle change?
*
RIGHT NOW!!!
I'm ready, but still have questions
Other
Are you interested in holding yourself EXTRA accountable and potentially earning extra income?
YES PLEASE
No thank you!
Not sure, tell me more
Other
The nuts & bolts
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
insta-gram and/or facebook name
*
I understand that Leia Morrison of Leia Morrison Wellness, LLC is not a medical professional and I am not using this wellness assessment to seek medical advice.
*
yes
Submit Form
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