Wondering if your gut health is on track?

1. What area(s) are you hoping to improve?

Overall Wellness

Weight Loss

Gut Health

Immune Support

Maintain Current Healthy Lifestyle

other

2. If weight loss is a concern, how many pounds would you like to lose?

3. How would you measure your cravings from day to day?

1. eating everything that comes to mind

2

3

4

5 willpower of an Olympian

4. How would you measure your energy from day to day?

1. extreme fatigue

2

3

4

5. energizer bunny

5. How would you measure your mobility from day to day?

1 extremely difficult to conduct usual tasks

2

3

4

5 ready to hike 5 miles

6. How would you measure your focus from day to day?

1. squirrel... what was the question?...

2

3

4

5. laser precision

7. In the past 12 months, which of the following symptoms have you experienced? click all that Apply *

8. Are there any medical concerns we should be aware of? If so, what?

Questions? Concerns? Comments?

Last ? Would you be more interested in reaching your goals Quickly OR Would you be okay with slow and steady and a little more flexibility?

QUICKLY

SLOW & STEADY

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Last Name *

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Take the Complimentary Wellness assessment to uncover if you might benefit from a gut reset.