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Your Complimentary Remission Roadmap Call

Welcome! Let’s Prep for Your Session

I am so excited to connect with you for your complimentary Remission Roadmap Session!

There is absolutely no pressure or hidden catch on our call. I use this quick intake form for two very important reasons:

Your Safety: Because my protocol uses powerful nutrition shifts, I want to ensure it is 100% safe for your specific body without any interactions.

Respecting Your Time: Reading your background beforehand allows us to skip the boring data collection and jump straight into the deep, personalized support you deserve the second we get on the line.

Please answer these 9 quick questions as openly and honestly as possible so we can make our time together incredibly valuable.

First Name *

Last Name *

Email *

I agree to the terms & conditions provided by LLW. By entering my email, I agree to receive messages from Laurie Landry Wellness.

Are you at least 18 years old? *

Yes

No

To ensure my coaching & this protocol is safe for your body, do you have any of the following conditions or medical restrictions? (Check all that apply) *

Organ issues/failures (such as kidney or liver disease)

Instructed by a doctor to limit daily liquid/fluid intake

Taking medications like Coumadin/Warfarin that require monitoring Vitamin K/green leafy vegetables

None of the above apply to me

What autoimmune disease or chronic illness are you trying to put into remission, and what are your most frustrating daily symptoms?

How long have you been struggling with these conditions or symptoms? *

Have you tried traditional treatment methods (meds, procedures, etc.) but find yourself looking for a solution to fix the root cause rather than just using "band-aid" methods to cover up the symptoms?

Yes, I am tired of just covering things up and want to get to the root cause.

No, I am comfortable staying on my current medical treatment plan.

I have NOT tried traditional treatment methods (meds, injections, procedures)

My methodology focuses heavily on reversing chronic inflammation through a targeted, whole-food, plant-exclusive, and high-raw nutrition protocol. Are you open and flexible about making these changes, even if they feel uncomfortable or different from what you've been told in the past?

Yes! I am fully open, excited, and ready to do what it takes to put my symptoms into remission.

I'm a little nervous about it being different, but I am willing to learn and try if it gets my life back.

No, I am not open to shifting away from meat, dairy, or cooked foods at this time.

We hate spam and will never sell or rent your information.

Your Complimentary Remission Roadmap Call

Welcome! Let’s Prep for Your Session

Thank you for filling out this survey!

What You'll Learn With This Free PDF

Secret #1

How to X Without Y So You Can Z

Secret #2

How to X Without Y So You Can Z

Secret #3

How to X Without Y So You Can Z

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