Free Health Assessment.
The information in this form helps me to focus our 30 min free assessment to what is most important to you. Complete as well as you can. Once it is completed, I will be in contact with you to arrange a time and date.
Facebook &/or Skype Name
(-12:00) International Date Line
(-11:00) Midway Island, Samoa
(-3:00) Brasilia, Buenos Aires, Georgetown
(-1:00) Azores, Cape Verde Isles
(0:00) Dublin, London, Monrovia, Casablanca
(+1:00) Paris, Madrid, Athens, Berlin, Rome
(+2:00) Eastern Europe, Harare, Pretoria, Israel
(+3:00) Moscow, Baghdad, Kuwait, Nairobi
(+4:00) Abu Dhabi, Muscat, Tbilisi, Kazan
(+5:00) Islamabad, Karachi, Ekaterinburg
(+5:30) Bombay, Calcutta, Madras, New Delhi
(+6:00) Almaty, Dhaka
(+7:00) Bangkok, Jakarta, Hanoi
(+8:00) Beijing, Hong Kong, Perth, Singapore
(+9:00) Tokyo, Osaka, Sapporo, Seoul, Yakutsk
(+9:30) Adelaide, Darwin
(+10:00) Sydney, Guam, Port Moresby, Vladivostok
(+11:00) Magadan, Solomon Isles, New Caledonia
(+12:00) Fiji, Marshall Isles, Wellington, Auckland
What is the best way to contact you?
Text/phone (make sure you add you phone number)
What are you most interested in?
GAPS (Gut healing protocol)
Low Carb High Fat
Trim Healthy Mamma
Vitamins & Supplements
Check all that apply to your health
High blood pressure
Diabetes or Pre-diabetes
Nervous system/sleep problems
Mental health issues
What are the top 3 health issues
What are your health goals and why is it important for you to reach them.
Type the characters from the image below.
Do Not Fill This Out