Discovery Questionnaire

Please complete this brief questionnaire so we can maximize our time together on the call.

First Name *

Last Name *

Email *

Phone *

Are you 18+ years? *

Yes

Do you live in the U.S./Canada? *

Yes

Do you live in the states FL, TN, or SC? *

No, I live in a different state or province

Yes, I live in FL, TN, or SC

Which state or province do you live in? *

What are your goals regarding your health? *

Your biggest symptoms. *

How many months or years have you had symptoms? *

Have you seen any health practitioners for help? *Check all that apply.

Where did you hear about me? *

My work number will show up as a 479 area code from Arkansas, at the time of our call. You will receive a confirmation text once your appointment is scheduled.

I Consent to Receive SMS Text Notifications. Message & data rates may apply. Text HELP for assistance. You can reply STOP to unsubscribe at any time.