Application Form - Go Nuts About Nutrition

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IBS and Gut Health for Plant-Based Eaters

ABOUT
- IBS
- MEET CLAIRE
WORK WITH ME
MEAL PLANS
- Cart
- Checkout
EXPLORE BLOG
FREE RESOURCES
CONTACT

APPLY TO WORK WITH ME

If you’re interested in working with me, please complete this short application form so I can understand what you’re struggling with and what you’re looking to achieve.

Applying doesn’t mean committing. There is no obligation to proceed.

Name *

First

Last

Email *

Do you have Irritable Bowel Syndrome? *

Yes
No
I think so

Have you been diagnosed by a doctor? *

Yes
No
Not yet, but this is in progress

What symptoms of IBS bother you the most? (select to to 5) *

Abdominal pain / Cramping
Bloating
Gas
Diarrhoea
Constipation
Nausea
Tiredness / Fatigue
Stress / Anxiety
Backache
Problems peeing
Bowel incontinence
Other

If you selected 'other' for the previous question, please describe symptoms here:

What have you done in the past to try and get relief from your IBS? What worked and what didn't? *

How would you describe your eating pattern? *

Vegan
Vegetarian
Flexitarian / Semi-vegetarian
Whole food, plant-based
Other

What is happening in your life right now that has prompted you to reach out to me for help? *

What would it mean to you to have control of your IBS? How would your life change? *

Is there any other information you would like me to know about your struggle with IBS?

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