Thank you for your interest in working with Janice. To ensure we are a good fit, please answer the questions below. It is important to provide an answer to every question.
When you have finished, click the "Submit" button. Your answers will be reviewed, and you will receive a response within five days.

PARENT INQUIRY FOR CHILD TO WORK WITH JANICE

First name

Last name

Phone

Your child's age

Why are you wanting to work with Janice? What kind of support are you looking for?

Does your child eat organic foods? If yes, approx what percentage of their food is organic?

Does your child eat fast food? If yes, how often?

Are you willing to make changes to your child's diet?

Are you willing to prepare the majority of your child's food at home?

Has your child received vaccinations? If yes, which ones? Are you planning on having them receive more vaccinations, including the flu shot? Did they receive the Covid vax and any boosters?

Do you use natural cleaning products in your home? If not, are you willing to make the change?

Does your child use natural body products? If not, are you willing to make the change?

Is your child taking any medications? If yes, please list the names and dosages and why they are taking them.

Are you willing to do whatever it takes to help your child heal? In other words, are you “all in”?

Services are not covered by insurance. Select your answer to this statement: "I will pay for costs that include consultation fees, testing and interpretation, and natural supplements."

Yes