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Discovery Call Application
A Little About You
First Name
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Last Name
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Email
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Preferred Phone
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*We only use this number to schedule your call – we respect your privacy
Health Concerns
What is your 3 main health complaints?
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How often does it bother you or your child ?
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How often does it bother you or your child ?
Every dayd
2-3 times a week
Once per week
Once per month
How long has it been going on?
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How long has it been going on?
1-6 months
6 months to 1 year
1-3 years
Over 3 years
Date of Birth
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Sex at birth
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Potential Roadblocks
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Potential Roadblocks
Children
Partner
Time
Money
Resources
Job
Fear
None
Your Journey So Far
What have you tried that worked or didn’t work?
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Describe current diet (be specific – meals & times)
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Supplements or medications you’re currently taking
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Your Vision
Where do you want your health or your child's health to be in 3–6 months?
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Biggest diet/lifestyle obstacles right now
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If we work together, what do you expect to achieve?
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What are 5 things you LOVE about your life or your child's life right now?
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On a scale of 1-10 how ready are you to invest in your health or your child's health right now?
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How Did You Find Me?
How did you find me?
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How did you find me?
Pinterest
Instagram
Facebook
Podcast
Websearch
Friend/Family
If Podcast or Referral – who should I thank?
Are you ready to commit to a structured plan that includes time, consistency, and financial investment?
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Are you ready to commit to a structured plan that includes time, consistency, and financial investment?
Yes
No
Book Your Discovery Call
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