Integrative Gut Health Institute Application Please enable JavaScript in your browser to complete this form.Legal NameFirstLastName for CertificateDate of BirthPhone NumberEmailAddress (Street, City, State, Zip)Current OccupationCurrent Employer / Business NameProfessional Licenses & CertificationsRNLPNNPMD/DONutritionistHealth CoachColon HydrotherapistMassage TherapistOtherProfessional Licenses & Certifications - OTHER. Please specify:Please list all current credentials/certificationsTell us about your personal health journey if you have one.At the Integrative Gut Health Institute, we believe the best practitioners often begin with their own healing journey. What experiences led you to become interested in gut health and holistic wellness?Have you personally experienced any of the following?Digestive IssuesAutoimmune SymptomsHormonal ImbalancesFood SensitivitiesChronic FatigueInflammationWeight ChallengesOtherIf OTHER, please specify:How has your experience influenced your desire to learn?Why do you want to attend IGHI? What specifically attracted you to the Integrative Gut Health Institute?What are you hoping to gain from this education?How do you plan to use your training?Personal HealthFamily WellnessExisting Medical PracticeFunctional Wellness PracticeColon Hydrotherapy PracticeHealth CoachingWellness CenterOtherIf OTHER, please specify:Where do you see yourself in 5 years?Gut HealthBeginnerInterAdvSTUDENT READINESS Please rate your current knowledge.NutritionBeginnerInterAdvSTUDENT READINESS Please rate your current knowledge.Detoxification BeginnerInterAdvSTUDENT READINESS Please rate your current knowledge. What please health Colon HydrotherapyBeginnerInterAdvSTUDENT READINESS Please rate your current knowledge.Hormonal HealthBeginnerInterAdvSTUDENT READINESS Please rate your current knowledge.Functional WellnessBeginnerInterAdvSTUDENT READINESS Please rate your current knowledge.The Integrative Gut Health Institute includes: I understandOnline Education: Digestive Anatomy & Physiology Gut Microbiome Nutrition Fundamentals Detoxification Principles Client Assessment Holistic Wellness Foundations In-Person Training: Colon Hydrotherapy Equipment Safety & Sanitation Client Intake Procedures Professional Boundaries Clinical Observation Bio-Electrical Lymphatic Drainage Hair Analysis Demonstration Business Modeling Hands-On Clinical Training: Colon Hydrotherapy Sessions Equipment Setup Client Communication Practical Skills Evaluation Red Light Therapy Sauna Detox Protocols Supplementation Introduction Post Certification Mentorship for 6 MonthsAre you willing to travel for in-person training?YesNoAre you comfortable participating in hands-on colon hydrotherapy training?YesNoNeed More InformationPersonal Essay (in 500 words or less): Why do you feel called to help others improve their health through holistic wellness and gut health education?Professional Reference NameProfessional Reference Phone NumberRelationshipReference EmailSTUDENT COMMITMENT: Please write your name and date. *I understand that acceptance into the Integrative Gut Health Institute is based upon professionalism, readiness, integrity, and alignment with the mission of holistic health education. Submit
