What Would Help You be Healthy & Happy!
The intention of this survey is to understand the real needs of real women, diverse in age, race, identity, lifestyle, socio-economic levels - towards living a life of their choice as a healthy and happy human being. By listening to you, the practitioners of Labrys Healthcare Circle will be creating Health and Wellness Classes and Programs starting in January 2020.

If you have any question please contact Roke Noir at labryshealthcarecircle@gmail.com or 510.681.9740.

Your information is safe with us. We respect your privacy and will not share this with anyone.

Thank you!
Labrys Healthcare Practitioners
Email address *
Name *
Your answer
Date of Birth (we want to wish you Happy Birthday)
MM
/
DD
/
YYYY
I need help with: (physical, mental, and/or emotional, life challenges that you are struggling with) *
Your answer
Things that get in the way of living a life I love are: (choose all that are relevant and add more at the end) *
Required
I want to: (choose all that are relevant and add more at the end) *
Required
I want to grow/develop life skills around: (choose all that are relevant and add more at the end) *
Required
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