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Discovery Call Form
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Email
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Your email
Name
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Your answer
Phone Number
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Your answer
Date of birth
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Are you scheduling on behalf of someone else?
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If yes, what is the prospective client's relationship to you?
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My child
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My parent
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Other
If yes, what is your first and last name?
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How did you hear about us?
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Where do you currently live?
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What challenges are you currently experiencing with your health, and for how long?
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Your answer
What are the biggest obstacles preventing you from reaching your health goals currently?
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Your answer
Select the honest statement that best matches your level of commitment right now:
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Choose
I am committed and ready to do what I need to do to experience greater health.
I want to feel better, but I am not sure I am ready to do what is required to get there.
I am not willing to make any changes to my life for the sake of my health at this time.
Is there time in your schedule to prioritize your health right now?
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Your answer
Is your health and healing a financial priority right now?
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Your answer
When it comes to making financial choices about your health care, are you the sole decision maker, or do you make decisions jointly with a spouse or partner?
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