new consultation form 1 Step 1 of 4 25% * YES! I am Ready to be a Healthy and Happy Mom! * Schedule me for a free 1:1 Inspired Health Consultation ($425 value) Check all boxes to be considered for this consultation.* I am ready to make my health a priority. I know that being healthy includes the whole body mind and spirit and am ready grow on all levels. I have a unique gift to share with the world and I am tired of my health preventing me from sharing. I am ready to invest in myself on all levels - Time, Energy and Money. Check all boxes to be considered for this consultation. What are you currently struggling with and feeling challenged by in your health?*On a scale of 1-10 (10 being highest), how important is it to you to get these solved...and WHY?*What would you like to get/have out of working with Dr. Goss?*How ready are you to put yourself first and why now?*What does it mean to you to be a magnificent mom?* Rate the following aspects of your life by satisfaction level from 0-10 (zero being completely absent from your life and 10 being total satisfaction, freedom, joy and abundance). Physical Health*Please enter a number from 1 to 10.Fitness*Please enter a number from 1 to 10.Mental & Emotional Wellbeing *Please enter a number from 1 to 10.Significant Other & Romance*Please enter a number from 1 to 10.Friends & Community*Please enter a number from 1 to 10.Family*Please enter a number from 1 to 10.Career Path*Please enter a number from 1 to 10. Name* First Last Hidden MM slash DD slash YYYY Phone*Email* * Yes, if I am selected as a candidate, I will make every effort to schedule my 1:1 Inspired Health Consultation within 3 days of being notified. I understand if I let this opportunity pass, I will forgo my session.