RESTORE Your Health NOW!
This information will not only help us to better assist your needs, but will better assist YOU to be on your way to a healthy, radiant & vibrant new YOU!
What are your goals? *
check all that apply
Required
Are you 100% dedicated to take charge of your health/life? *
It is important to understand that only YOU can change the way your story ends or begins
What are your eating and life habits like now? *
check all that apply
Required
What is your current health like now *
Your answer
Do you consume alcohol on a regular basis *
Are you taking Rx drugs *
if so what and how many
Your answer
Are you under the care of a doctor *
Are you allergic to any foods / herbs *
Required
What foods will you NOT give up *
Your answer
Do you incorporate any exercise in your daily routines *
What is your preferred line of consultation *
Please provide your name, email, phone number / or best way to communicate *
Also provide the best time of day for your consultation. Evening works best for us
Your answer
Your gender
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