Form

Client Application

Please complete this application thoroughly to help us assess whether you're a good fit to work with our team!

After you complete the application you'll receive an invitation to book a 30-minute discovery call with Allie. This call with provide an opportunity to discuss your health goals in more detail.

Email*

Last name*

First name*

Phone number*

How did you hear about RestoRD by Allie? *

State/Region*

Current location (Only accepting US clients at this time)

Date of birth

What prompted you to reach out at this time? *

What are your health goals over the next 8-12 months? *

Please describe in detail what your top 3 goals you would like to achieve.

What has been the biggest barrier to reaching your health goals? *

What is the most frustrating thing about the symptom(s) you are experiencing? What steps have you taken thus far to address them?*

Why do you think you havn't been able to reach your health goals on your own? *

This personalized and functional medicine approach leads to remarkable success and health transformations for clients within as little as 4 months. Recognizing that it entails both emotional and financial commitment, how ready are you to take action and make a financial investment in yourself to achieve your personal goals?
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In our 1-on-1 program, we request for an initial 4 month commitment. The program investment starts at $3597 with payment plans available & this covers specialty functional lab testing. We do accept HSAs & FSAs but do not take insurance.*

Allie is currently scheduling appointments several months in advance. She leads a team of expert dietitians who administer the same tests, follow the same philosophy, and engage in regular collaboration with Allie. Do you have a specific preference regarding which practitioner you would prefer to work with?

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I would like to keep my name on Allie's wait list only.

I am open to working with anyone on Allie's team.

I am unsure and I would like to discuss options further on a call.