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Contact Form
Please fill in the following questionnaire, afterwards, you will receive a call invitation to speak directly with Dr. David Castol for a quick assessment.
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Email
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Your email
First Name
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Your answer
Last name
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Your answer
Gender
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Female
Male
Other:
Date of Birth
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MM
/
DD
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YYYY
Telephone (ex. +12 345678900)
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Your answer
Country and city of Residence
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Your answer
Country of Origin
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Your answer
If you had one "Burning question" you would like an answer for, what would it be?
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Your answer
What is the reason (necessity) that brought you to seek our services and how do you expect we can help with your objectives?
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Your answer
What are your immediate short term health objectives?
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Your answer
How do you picture yourself in the last decade of your life?
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Your answer
Is there a particular issue you would like to address?
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Your answer
In the past, in what ways have you been successful in addressing your health objectives?
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Your answer
In the past, in what ways have you struggled to make progress with your health?
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Your answer
On a scale from 0-10, how much impact do you think Lifestyle (behaviour) has on your overall health.
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On a scale from 0-10, how much impact do you think Sleep has on your overall health.
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On a scale from 0-10, how much impact do you think Mindset has on your overall health.
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On a scale from 0-10, how much impact do you think Stress has on your overall health.
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Very significant
On a scale from 0-10, how much impact do you think Movement (exercise) has on your overall health.
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Very Significant
On a scale from 0-10, how much impact do you think Food (Diet) has on your overall health.
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Very significant
What is the area of your health you wish to improve the most?
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Your answer
How would you most accurately describe your current motivation and commitment in working towards your health?
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Very motivated and understand my health is a longterm commitment
Very motivated but hoping for a quick fix to my problems
Poorly motivated but willing to commit to a longterm process
Poorly motivated and hoping to find a quick fix
Do you consider yourself open to new / alternative approaches towards improving your overall health?
*
Yes
No
Maybe
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