TELL ME ABOUT YOURSELF
What time zone are you in?
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How did you hear about the Mind Body Rewire Program?
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If a person referred you, please type their name below
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Do you work at this time?
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Your Age
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What are your biggest struggles when trying to heal your symptoms?
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What symptoms/diagnosis are you seeking help for?
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How long have you had these symptoms?
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What kind of approaches have you tried to resolve these symptoms?
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How does having these symptoms and not finding the solution make you feel?
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If you could wave a magic wand when it comes to your health, what would your #1 desired outcome be in the next 6 months?
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What do YOU believe is the root cause to your symptoms?
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Have you ever worked with a coach or mentor before?
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What percent do you believe you are responsible for your healing?
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On a scale of 0-10, how willing are you to be uncomfortable for the sake of your healing?
- 10 being that you know shifting old patterns can be uncomfortable but understand that its necessary to heal and are willing to do it.
- 1 meaning you don't want to be uncomfortable and you're not willing to make any changes to create the result that you want.
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Are you willing to put your healing and the work that is required for your healing as a priority in your life? This means you will need to spend 30-90 minutes a day on your healing.
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Are you open to the idea that physical ailments have an emotional connection?
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What would be the length of time that you are willing to invest in your healing?
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What kind of solution are you looking for right now?
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The MBR Program includes a variety of tools to assist with healing including, meditation, yoga, and hypnosis. Are you ok with using these?
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What do YOU think is the biggest block getting in the way of your healing?
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What are the biggest reasons you're drawn to working with a coach versus healing on your own?
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Are you on any medications? If yes, which ones?
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Are you open to healing your symptoms without detoxing, diet restrictions or pills?
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Have you listened to Jenny's Podcast (Simplify Your Healing Podcast) and have a good idea of the type of work that Jenny and her team does?
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The MBR Program is a minimal investment of $1500. Does this fit within your budget or your ability to find the funds?
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May we inform you by text if you've been accepted?
If your application is accepted, we will send you the time-sensitive reply link via email. By checking this box, you also give us permission to text you and let you know to keep an eye out for that email. We are only using this for internal purposes only.
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