Are you ready to start feeling better? This is the first step in your journey to better health! Name * First Last Email Address * Phone * Address Field * Address Line 1 * Address Line 2 City * State * Zip Code * This is only for your account... we will not be sending you SPAM mail. Age: * How did you hear about us? * What are your main health complaints? * Do you struggle with emotional stressors, such as depression, PTSD, anxiety, constant worry, or OCD? * — Select — No Yes Please explain: * How often do you struggle with worry or anxiety in your daily life? * — Select — Never Rarely Weekly Daily What do you want your ideal health to look like in the next 3-6 months? * Why do you think you have not achieve those goals so far? * On a scale of 1-10, how important is it for you to solve these health problems right now? * — Select — 1 - Not at all important 2 - Very minor importance 3 - Slightly important 4 - Somewhat unimportant 5 - Moderately important 6 - Fairly important 7 - Considerably important 8 - Very important 9 - Extremely important 10 - Of the utmost importance Your total health is significantly influenced by the state of your mental, emotional, and spiritual well-being. It's not just unhealthy eating, like indulging in fast food, that can affect your health – chronic stress and job dissatisfaction can be just as damaging. Our methods are designed to create deep, lasting changes, with no room for quick, surface-level fixes. How would you rate your readiness, on a scale of 1 to 10, to delve into the mental and emotional facets of your health? * — Select — 1 - Completely unwilling 2 - Reluctant 3 - Marginally willing 4 - Slightly willing 5 - Moderately willing 6 - Fairly willing 7 - Very willing 8 - Eager 9 - Highly modivated 10 - Wholly committed Is there anything else you would like us to know? * — Select — Yes No Use this box to give us any extra details: *
