Hormone Health Evaluation

I'm so excited that you're considering taking the next step toward healing and understanding your body from the inside out! KH & Co. Wellness is a high-level, personalized program for those ready for change. Because of the depth of support I provide, spots are limited.

Please take your time filling this application out thoroughly. The more I know, the better I can support you. Only submit this form if you are serious about getting answers, making changes, and investing in your health. Half-in doesn't get results...and I want to help YOU get results. That takes commitment on both of our parts.

I review every application carefully and will be in touch once I've looked things over in detail. Ready to get the support you deserve? Let's get started.

Full Name *

Email *

Phone *

Date of birth *

Instagram Handle *

SEVERE WEIGHT LOSS RESISTANCE ASSESSMENT:

Are you currently on birth control? If yes, which one? *

Do you have any children? If yes, please list ages *

Do you have any current medical conditions? If yes, please share how it affects you and anything I should know. Remember, always check with physician before making any lifestyle changes. *

What does a typical day of eating look like? What is your biggest struggle? (over eating, craving, etc) *

Are you experiencing anything that makes you believe your hormones are off (fatigue, low sex drive, anxiousness, hair loss, etc) *

Tell me about your cycle. Is it regular, irregular? Do you have heavy days, clotting, PPMD? *

How often do you have bowel movements? Please describe the consistency (hard, soft, loose, etc) and any other characteristics you notice (color, frequency, discomfort, etc) *

Please list any medications you are currently on. *

If you have labs from the last 60 days, please email to [email protected] with "Labs: Your Name" as the subject line. *

What goals are you looking to achieve in the next 6 months? *

Is there anything else you feel I need to know? *

Do you have a support system in this journey? Check all that apply. *

Spouse/partner 100% supports me and wants me to feel better

Spouse/partner is skeptical, but will support me

Spouse/partner doesn't really support me on this journey

No support...just you and me girl

What is holding you back from reaching your goals? *

Working with me inside KH & Co. Wellness starts at $350 per month. This is a high-touch program designed for women who are ready to take real action toward healing and understanding their bodies. Are you willing and able to invest in you? *

Yes, but I'm nervous

Yes, I need this NOW!

Unsure, but would love to chat

No, just want your thoughts

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested from KH & Co., LLC Kelly J Hoover Sole MBR. These messages may include appointment reminders, order confirmations, and account notifications, among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, and new product updates, among others from KH & Co., LLC Kelly J Hoover Sole MBR. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt out.