Fill Out your IBD Application for a Complimentary 60-min Private Session with your IBD Support Specialist

Before we schedule your complimentary IBD strategy session, please take 3-5 minutes to tell us about your case and apply for a 1-on-1 session with our IBD support specialist. Please be specific about your symptoms, past experience, what you feel you need to get the results you desire. We looking forward to helping you get MASSIVE results!

Full Name *

Email *

Phone *

Health History Questionnaire

Please fill out the following questions to the best of your ability so we're more prepared to help you achieve your goals of getting symptom free!

Are you fluent in English? *

Yes, I'm fluent in English

Pretty good, but English is my 2nd language

Somewhat, I need translation support

No, I speak very limited English

What have you been diagnosed with? *

How many years has it been since you were diagnosed with Crohn's Disease, Ulcerative Colitis or IBD? *

Would you consider yourself in a healthy state of mind? *

Yes

No

Have you seen a Naturopathic Doctor or Holistic Practitioner before? What was your experience? *

Yes, I have had good results with natural medicine or a N.D physician in the past

Yes, but I had a poor experience with natural medicine or a N.D. physician in the past

No, I haven't seen a N.D. Physician or someone to train me in natural medicine

Imagine a future where you find real relief and healing from IBD. If we could partner with you to create a 100% customized approach for your healing and symptom relief, would you be ready to invest in your health? *

Yes, I am ready to heal!

Maybe, if this really works and there is split payment options.

No, I don't have the ability to invest in my health.

Are you on any prescription medications? If so, which ones? *

Is there anything else you would like to share with us?

I want to receive post consultation emails. *

Yes

No

Please confirm below you are 100% committed to showing up for your IBD strategy session at the time you will schedule. Our specialist are extremely busy and need to know you're fully committed to your complimentary IBD session. *

Yes, I’m 100% committed to showing up for my IBD session

Signature *

Clear

Complimentary sessions are subject to denial based on intake form submissions and a persons capability with CCL’s language, country origin, financial stability and other factors at companies discretion. A persons data may be deleted upon request by email [email protected]

PLEASE NOTE: Your name, email, number will never be spammed, sold or public. This information is 100% private, we only need it to call you for your session. Click here to see our Privacy Policy.

IBD PODCAST INTERVIEWS

Ben Greenfield Podcast

Mark Groves Podcast

Kenny Honnas Podcast

Terms & Conditions | Privacy Policy

100% Secure. We Never Share Your Info.

We are in Full Compliance with COVID-19 Safety Procedures, including;

Fill Out your IBD Application for a Complimentary 60-min Private Session with your IBD Support Specialist

IBD PODCAST INTERVIEWS

Ben Greenfield Podcast

Mark Groves Podcast

Kenny Honnas Podcast

Fill Out your IBD Application for a Complimentary 60-min Private Session with your IBD Support Specialist

Client Testimonials

Due to the overwhelmingly positive response to this promotion, we currently have your spot reserved until you book an appointment. For any questions or concerns, please reach us at [email protected]. Leave a message if after hours with your name and we will get back to you right away!

© 2024 Crohn's/ColitisLifestyle. All Rights Reserved.

100% Secure. We Never Share Your Info.

We are in Full Compliance with COVID-19 Safety Procedures, including;

Fill Out your IBD Application for a Complimentary 60-min Private Session with your IBD Support Specialist

IBD PODCAST INTERVIEWS

Ben Greenfield Podcast

Mark Groves Podcast

Kenny Honnas Podcast

Fill Out your IBD Application for a Complimentary 60-min Private Session with your IBD Support Specialist

Client Testimonials

*Due to the overwhelmingly positive response to this promotion, we currently have your spot reserved until you book an appointment. For any questions or concerns, please reach us at [email protected]. Leave a message if after hours with your name and we will get back to you right away!*

© 2024 Crohn's/ColitisLifestyle. All Rights Reserved.

Due to the overwhelmingly positive response to this promotion, we currently have your spot reserved until you book an appointment. For any questions or concerns, please reach us at [email protected]. Leave a message if after hours with your name and we will get back to you right away!