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Free Consult Form
complimentary phone consult questionnaire
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First & Last Name
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Your answer
Age
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Your answer
email
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Your answer
Phone number
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Address
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City
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State
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Zip Code
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Country
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How Did You Hear About Dr. Linda
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What is Your Main Health Concern?
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Your answer
When Did It Start?
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On a 1-100 scale (100 being very healthy & 1 very unhealthy) where do you rank your health?
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Your answer
Where do you want your health to be on a 1-100 scale (1=poor 100=excellent health)
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Your answer
How long do you think it will take you to get to your health goal stated above?
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Your answer
What are some areas in your life (work, home, sex, relationships, travel, every day activities) that are affected because of your current health condition/status? What health concerns are keeping you up at night, or from living the best life?
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What is your single biggest challenge that is holding you back from feeling healthy, vibrant and the best version of YOU right now?
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Your answer
What are the top three things you would like to change or make better in the next 3 months in regards to your health?
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How would your life be if this change happened (example: I would be able to play with kids, I would be able to travel more)
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If you transformed your health, how would that make you feel?
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Your answer
When you have tired to change before, what happened? What has held you back? What blocks have kept you from changing?
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Why are you interested in having someone help you with your current health issues?
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How willing are you to invest in yourself and what types of things have you done before?
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Why is it important to change now?
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On a scale of 1-100 (1=not very important 100=very important), how important is this to you?
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What kind of support is most helpful to you?
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How will you know how effective our engagement has been?
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What specifically would you like to talk about during this strategy session?
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What single action can you take now that would help you with your current health issues and that you haven't done already, yet you know if you just did it, it would change your current health issue dramatically?
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Your answer
How willing are you to make substantial changes to your thinking, behavior, and actions?
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