Elemental Health: Health Quiz

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Please complete the survey below. The doctor looks forward to seeing you at the webinar!

Full Name *

Phone Number *

Email *

What drove you to register for this presentation? *

I am a cancer survivor and am looking for help with the side effects of treatment.

I am a cancer survivor and want to learn about how I can prevent its recurrence.

I have been diagnosed with cancer and am looking for an alternative to conventional treatment.

I don't have cancer but have other risk factors/conditions that may lead to cancer and want to prevent it.

Required

I am most interested in learning about... *

Hormone Health

Strengthening my immune system

How to prevent cancer

Weight management

Increasing my energy levels

Other:

What is your biggest struggle with implementing a healthy lifestyle? *

Time

Energy

Stress

Lack of knowledge

Trouble sticking with changes

Lack of support

I want a practitioner who... *

knows my personal health goals and helps me achieve them.

teaches me what to do to be healthier.

provides support and motivation.

Submit

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