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Application for Wellness Accelerator System - Phase 1
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* Indicates required question
Email
*
Your email
Date of birth
*
MM
/
DD
/
YYYY
Time of birth
*
Time
:
AM
PM
Why do you want to be healthy? (Choose one that resonates with you)
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My health complaints are getting on my way to do what I want
Without health I can't achieve what I want in life
Are you curious about how your body and mind work?
*
Yes
No
I just want to get rid of my health complaints
Where do you turn to change your immediate EXTERNAL environment? |This is a tricky one :)|
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Outside yourself
Inside yourself
Do you have religious restrictions about turning inward to explore your body for causes of your health complaints?
*
Yes
No
I'm willing to put in the work, time (1 hr daily for 6 months), and the investment to improve my health and feel better every year.
*
Yes
No
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