PMDD Coaching

Apply to work 1:1 with Jes!

Please fill out this form to apply for an upcoming open spot in Integrative Menstrual Health Coaching

Name

How did you hear about us?

Are you applying for:

Are you a PMDD Rehab student?

Age

Where are you located?

What is your occupation?

What motivated you to reach out?

When did you begin experiencing the cycle symptoms you are currently seeking support for?

How long is your cycle from bleed day 1 to the next bleed day 1?

What are the most challenging symptoms you are facing?(physical/psychological)

What have you tried so far to address or manage these symptoms?

How has your life been negatively impacted by your current cycle symptoms?

On a scale of 1-10. 1 being not at all & 10 being 100% ready- How ready are you to commit to a targeted program in order to improve your cycle health & wellbeing?

Do you adhere to any dietary restrictions: vegan, vegetarian, dairy free, etc.?

What medications and supplements do you currently take?

What providers or practitioners are you currently working with to address your premenstrual symptoms? (gyno, counselor, dietitian, naturopath, acupuncturist, etc.)

Why are you interested in working with Jes?

I am only able to take on 3 new coaching clients each month. If I am at capacity you can claim a spot for the upcoming month, or start with the PMDD Rehab course & move to into coaching later, or be added to a waitlist. Please confirm you understand.

Apply to work 1:1 with Jes!

Please fill out this form to apply for an upcoming open spot in Integrative Menstrual Health Coaching

Apply to work 1:1 with Jes!

Apply to work 1:1 with Jes!

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