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Restoration programs at Align for Life
Please complete this brief application to help determine your eligibility. You will get a response within two business days.
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Name
*
Your answer
e-mail
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Your answer
Phone number
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Your answer
Age
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Your answer
Are you looking to:
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Resolve immediate concerns
Start a lifestyle program for optimal living
Both
Other:
Are you able to complete on-line course work?
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yes
no
Briefly describe your current symptoms.
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Your answer
What have you already tried to resolve these problems?
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Your answer
How are these issues holding you back from your life, career and aspirations?
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Your answer
Why is now the right time for you to address these issues?
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Your answer
Are you open to making changes in your daily routine?
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yes
no
Do you think friends and family will be supportive of you making changes?
yes
no
Clear selection
What drew you to inquire about the Restoration programs?
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Your answer
Are you able to invest the time, mindset and means to address your concerns?
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I have the necessary means to invest in my health and future
I have the ability to get the necessary means to invest in my health and future
I have no financial means to invest in my health and future
Other:
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