One-to-One Health & Wellbeing Kick Start Strategy Session
Please enter your contact details and best time to contact you on the boxes below, and a member of our team will be in touch shortly
Full Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
E-mail
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Skype Name
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GENERAL QUESTIONS
What do you actually want to get out of our session?
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What health issues are you facing at the moment?
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How are they affecting your life at the moment?
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What have you tried already?
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How important is it for you to resolve this issue?
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What will happen if you do not resolve this issue?
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What has this issue cost you emotionally, financially and physically?
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What will you be willing to invest in time, money and effort to get where you want to be?
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GENERAL HEALTH QUESTIONNAIRE
The following three questions: 1 - 10 (1=poor / 10=excellent)
How do you rate your current level of health
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How do you rate your current level of energy and vitality
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How do you rate your current stress levels
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How do you rate your current eating & drinking habits
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Please list any medications and/or supplements that you are currently taking
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Have you had any root canals and/or implants? If yes, how many & how long ago did you have them?
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Refundable Booking Fee
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