Chat with meBOOK A FREE CURIOSITY CALL Name * First Name Last Name Email * Phone (###) ### #### What is your main health complaint? * How often does it bother you? * EVERYDAY ONCE PER WEEK 2 or 3 TIMES PER WEEK ONCE PER MONTH How long has it been going on? * 1-6 MONTHS 1-3 YEARS OVER 3 YEARS Who (or what) would prevent you from completing a health building program? CHILDREN SPOUSE TIME SELF MONEY RESOURCES JOB FEAR What have you tried so far that has or has not worked? * What is your current diet like? Please be specific: list breakfast, lunch, dinner and snacks, as well as the times you eat. * Are you taking any supplements or medications? Please list what you take and what it's for. * What would you like your health to be in 3 months from now? How about 6 months from now? * What obstacles, challenges, and struggles do you face regarding diet/lifestyle? * If we were to work together what would you expect to achieve from working with me? * What are 5 things you LOVE about your life? * Thank you! Looking forward to speaking with you soon.
