First Name *

Last Name *

What age range do you fall into? *

What are your top 3-5 health challenges right now? (exhaustion, hormone imbalance, bloating, trouble losing weight, skin issues, lack of mental clarity, irregular periods, constipation, moodiness, low energy, etc) *

Often times, people will try good things but it may not be what they personally need, or it is not done at the right time or in the right order. What interventions have you tried in the past that have NOT succeeded in resolving your issues? (For example: diet, cleanse, medication, supplements, reducing stress, seeing a primary care physician, etc.)

Time is important and we cannot get it back. My clients are business owners, doctors, high achieving professionals, executives & celebrities who value their time. Once they realize how long they have been dealing with their health issues with no change, they make the decision to address their health once and for all.

How long have you been dealing with this health issue? *

Clients come to me because they want personalized care. Sometimes they have invested a lot of time and money doing things that they hoped would work, but left them disappointed or did not provide them with long term results.

How much have you financially invested in your health attempting to address this issue in the last 2 years? (ie. Supplements, cleanses, prescriptions, doctors visits, surgeries, online challenges, books, courses, gadgets, treatments, devices, therapies, etc) *

Most clients come to me frustrated from their experience with previous doctors.

A prior client notes, “It is so valuable to have a doctor sit down and listen. Oftentimes, we go to a doctor for help and they are in and out within minutes. Being seen, heard and validated is something I needed so badly. Dr. Alicia really cares, she listens and she is like a detective who pays attention to every detail. That is why what she does works and how she is able to help so many people”

What are your biggest fears and frustrations when it comes to your health? *

Many of my clients come to me because their health issue is affecting other areas of their life. Here are some examples: Not enough energy to work on business or play with kids, moodiness affecting relationships, low sex drive, not feeling sexy naked, bloating that is uncomfortable and embarrassing (ie. Looking pregnant when you’re not), painful, heavy or irregular periods that interfere with life, not wanting to take pictures due to not feeling like yourself, lack of motivation to get things done.

I want to understand, which areas of your life are being impacted by your current state of health? *

Note: I used to suffer from unexplained weight gain, depression, moodiness, heavy painful periods, embarrassing acne, and terrible fatigue. I would push through my day only to be exhausted by the end, fall asleep on the couch. Then get up the next morning to do it all again. I felt like a bad mom, a failing wife and a stressed out business owner. After years of research and wasting time going to other doctors who didn’t understand what was going on inside my body or only wanted to offer me drugs, I finally got the answers I needed to turn my life around. Now I am full of energy, have easy predictable periods, I feel good in my clothes and in my skin and I am able to focus on the things that matter to me the most because I have tons of mental clarity! My kids are thriving and my husband is my best friend. Now I'm the doctor other doctors turn to for answers. It feels so good to be walking in my purpose!

Imagine for a moment that your current health challenges are a thing of the past and you are thriving, not only in your health but in every area of your life. What do you see is now possible? What would excite you most about life? What goals would you now be able to achieve? What are your greatest desires? *

I am thrilled to get to know you!! And I KNOW you are Brilliant. You are brave and already taking the next step to fill out this application and transform your life, relationships and work! I am curious to know, what is your SUPERPOWER that will help you achieve success while applying all the knowledge, tips, tricks and personalized hacks that Dr. Alicia will provide you? (This is your opportunity to brag on yourself!) *

When you invest in a VIP day, not only will you have a 3-4 hour session with Dr. Alicia, but you will have a 90 minute pre-VIP day call and a 30 minute follow-up call. There will also be genetic lab testing, advanced functional medicine labs, and pre-work which involves neurotoxic, neurocognitive questionnaires & assessments. The blueprint is customized to you and your needs- nutrition, targeted supplementation, sleep, exercise, stress reduction techniques that work, true cellular detoxification, etc. You most likely have never received such detailed and personalized information in the past. And we are so glad you are here!!

Every person who works with Dr. Alicia is different and therefore every person needs customized solutions that are delivered in a way that works best for them. Dr. Alicia invests a lot of time and energy into ensuring the success of each of her clients.

Before you are invited to participate in one of Dr. Alicia's Customized Programs, please note that Dr. Alicia and her team only work with a few select women who are ready to invest the necessary time, energy and money into identifying and resolving the root causes of their hormonal imbalances & health issues.

Please indicate what level of involvement you're ready to commit to: *

VIP day + ongoing 1:1 coaching + Dr. Alicia flies to my home to help me get my life together $$$$$ (Do it ALL with me, Doc I really need your help)

VIP + ongoing 1:1 coaching $$$ (Coach me. I will get it done, I just need some accountability & support)

VIP day $$ (Give me the answers I am looking for, map out my plan to get it done and I will make it happen)

Consultation $ (I desire to work with Dr. Alicia, but I really want to have a consultation first)

I’m not really sure, I am just here looking for information.

100% of my clients report getting their life back and now having more energy and mental clarity to do the things they love.

The celebrities, executives, business owners, doctors and high achieving professional women that I work with are purpose driven people (ie. People who want to have an impact in the world and help other people with their gifts).

Tell me, who do you plan to help, be more present with or what project do you plan to complete as you optimize your health? (ie. Who is waiting for you to invest in yourself so you can show up fully as your best self?) *

Where did you first hear about Dr Alicia? *

Please confirm you email address (This is backup to make sure your answers are saved correctly) *

Optional: What is your Instagram handle & Linkedin? We’d love to connect with you on social media!

We kindly request that you provide a contact number for communication purposes related to your application. Your consent to be contacted by our team is necessary when sharing your phone number with us. Please note that your privacy will be respected. *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.