The Root Cause Clinic Application Form

Please Note: Summer currently only works with women 21 and older in the US & Canada. If you are located internationally, please email summer@healwithsummer.com to check availability for international support.

First & Last Name

State or Province

Please share a bit about your current health struggles:

How would your life change if you were able to overcome these struggles?

What have you been struggling with on your own to achieve this goal? How long have you been struggling with this?

What do you do for work?

On a scale of 1-10, with 1 being I am content with my current health and 10 being I need to make a change now, where do you fall?

Our program is for those who are deeply committed to healing their symptoms. Which option below best describes you?

Yes, I'm willing & able to make a minimum $2,897 USD investment in my health.

I have access to at least $1,027 USD now & would like to learn more about payment plans.

I am based in the US & have good credit to explore financing options as low as $242/mo USD with Afterpay.

I do not have any resources to invest in my health right now but I want to learn more about working together in the future.

On the next page, you will have the option to join The Root Cause Clinic or book a discovery call. Is there anything else you would like me to know?