1:1 Session with Celine

Application form

Name

First Name

Last Name

Phone

(###)

###

####

Instagram Handle

Include your Instagram handle here if you would like to be contacted via Instagram DM

Age range

to better tailor my support based on your needs

Under 20

20-25

25-32

32-40

40+

What country are you currently residing in, and what is your time zone?

How did you hear about us?

Describe your symptoms

Give me as many details as possible so I can get an idea of how I can support you on this health journey