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Work With Me
Testimonials
Contact
Get My Book
Heal Yourself
Application For a FREE 20 Minute Health Assessment
Name
*
First Name
Last Name
Email Address
*
Time Zone
*
What are your main health issues?
*
What have you tried so far?
What medications or supplements are you currently taking?
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What do your health issues prevent you from doing?
*
What would your life look like free from your health issues? Describe in detail
*
What do you think will happen if you don't address your health issues now?
*
How committed are you to healing your body?
*
What will prevent you from reaching your health goals?
*
What specifically do you want to discuss in your Health Assessment?
*
What kind of results would you like to see in the next 3 to 6 months?
*
Referred by
Phone
*
(###)
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Do you have the financial resources to invest in your health?
*
Thank you!
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