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Name*
Address*
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Do you consider yourself coachable?*
Do you have a supportive spouse, significant other, or friend to support your personal goals?*
Have you experienced significant trauma (emotional, physical)?*
Who else have you worked with?*
What functional lab testing have you had done?*
Are you willing to do what's necessary to reclaim your health? (This may include, dietary modifications, functional lab testing, lifestyle and environmental modifications)*
If we can find a natural solution to address your health goals, which solution do you prefer?*
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When submitting this form you will be taken to the next best step based on your responses above! We look forward to working with you :)

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