Radical Wisdom...The Art of Living Well
6-Month Program Application & Intake Questionnaire
Email *
Full Name *
Email *
Phone Number *
What is your main health complaint? *
How often does it bother you? *
How long has it been going on? *
What have you tried that has not worked? *
How does this affect your life, or what does it prevent you from doing?
Who or what (fear, money, time) may stop you from completing a health rebuilding program (who will support you)? *
What would you (reasonably) expect to achieve while working with me? *
On a scale of 1-10, how committed are you to solving your main health complaint? *
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