Discovery Call Optin First Name*Last Name*Email* Phone*What is your main health complaint?*How often does it bother you?* Everyday Once per week 2 to 3 times per week Once per month How long has it been going on?* 1-6 months 1-3 years Over 3 years What (or who) would prevent you from completing a health-rebuilding or weight loss 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?*I want to get awesome health tips, tools and resources Yes! NameThis field is for validation purposes and should be left unchanged.
